Evaluation and Improving Treatment Plans of Gated Radiotherapy in Left-Sided Breast Cancer Patients Using Respiratory Motion Management System for Deep Inspiration Breath-Hold (DIBH)

Abstract

Background: One essential part of treating breast cancer is radiation therapy. Patients with breast cancer are more likely to develop cardiac problems and die if they accidentally expose their hearts to radiation. In order to minimize radiation exposure to the heart, the deep inspiration breath-hold technique (DIBH) has been implemented into clinical practice. This study aimed to assess the use of the Varian Respiratory Motion Management System (RGSC) for radiation application in DIBH, with a focus on dosimetric plan comparison and treatment planning during free breathing (FB) and DIBH Methods and Material: This prospective clinical trial comprised 100 patients with left-sided breast cancer who had undergone breast-conserving surgery. Gating control and the RGS system were employed for therapy application. Analytical anisotropic algorithm (AAA) was used to generate dual treatment plans after CT data were obtained in FB and DIBH. Using the Dose Volume Histogram (DVH), dosimetric output parameters of organs at risk were compared. Results: The RGSC is connected to the LINAC systems and enables con- tinuous, touchless respiratory motion tracking using a camera. After each patient underwent dual treatment planning, 50 patients received treatment in Intensity Modulated Radiotherapy (IMRT) using DIBH, while 50 more patients received treatment in IMRT using Free Breath (FB). The mean cardiac dose reduction for DIBH in these patients was 7.23 to 3.41 Gy when compared to FB. Conclusion: The current data demonstrate that RT could greatly lower mean doses to the heart and high-dose locations by implementing the DIBH approach.