Abstract
Deep inspiration breath hold (DIBH) in left‐sided breast cancer radiotherapy is a technique to reduce cardiac and pulmonary doses while maintaining target coverage. This study aims at evaluating an in‐house developed DIBH system. Free‐breathing (FB) and DIBH plans were generated for 22 left‐sided localized breast cancer patients who had radiation therapy (RT) after breast‐conserving surgery. All patients were treated utilizing an in‐house laser distance measuring system. 50 Gy was prescribed, and parameters of interest were target coverage, left anterior descending coronary artery, (LAD) and heart doses. Portal images were acquired and the reproducibility and stability of DIBH treatment were compared to FB. The comparing result shows there is a significant reduction in all LAD and heart dose statistics for DIBH compared to FB plans without compromising the target coverage. The maximum LAD dose was reduced from 43.7 Gy to 29.0 Gy and the volume of the heart receiving >25 Gy was reduced from 3.3% to 1.0% using the in‐house system, both statistically significant. The in‐house system gave a reproducible and stable DIBH treatment where the systematic error ∑, and random error σ, were less than 2.2 mm in all directions, but were not significantly better than at FB. The system was well tolerated and all patients completed their treatment sessions with DIBH.
Highlights
Clinical importance of radiation-induced heart disease is well known, and there is growing evidence of a relation between radiotherapy (RT) and cardiovascular events.[1,2,3,4] Increased morbidity and mortality rates from cardiovascular damage may lower the survival rates.[5]
Excluding the heart from the field might compromise the dose to the target, but by means of the deep inspiration breath hold (DIBH) technique it is possible to reduce the cardiopulmonary doses while maintaining the prescribed dose to the breast.[6,7]
Patients had to maintain a stable breath hold for at least 20 s to be eligible for DIBH, and two patients were not able to comply with the requirement and were excluded from the analysis
Summary
Clinical importance of radiation-induced heart disease is well known, and there is growing evidence of a relation between radiotherapy (RT) and cardiovascular events.[1,2,3,4] Increased morbidity and mortality rates from cardiovascular damage may lower the survival rates.[5]. Excluding the heart from the field might compromise the dose to the target, but by means of the deep inspiration breath hold (DIBH) technique it is possible to reduce the cardiopulmonary doses while maintaining the prescribed dose to the breast.[6,7] The method is well established and several groups have previously reported beneficial results using DIBH.[6,8,9,10,11,12,13,14] Since DIBH is capable of decreasing dose to the heart; it is assumed that the long-term risk of developing cardiac damage is reduced
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