Voluntary deep inspiration breath-hold reduces the heart dose without compromising the target volume coverage during radiotherapy for left-sided breast cancer

  • Noora Al-Hammadi National Center for Cancer Care and Research, Hamad Medical Corporation
  • Palmira Caparrotti National Center for Cancer Care and Research, Hamad Medical Corporation
  • Carole Naim National Center for Cancer Care and Research, Hamad Medical Corporation
  • Jillian Hayes National Center for Cancer Care and Research, Hamad Medical Corporation
  • Katherine Rebecca Benson National Center for Cancer Care and Research, Hamad Medical Corporation
  • Ana Vasic National Center for Cancer Care and Research, Hamad Medical Corporation
  • Hissa Al-Abdulla National Center for Cancer Care and Research, Hamad Medical Corporation
  • Rabih Hammoud National Center for Cancer Care and Research, Hamad Medical Corporation
  • Saju Divakar National Center for Cancer Care and Research, Hamad Medical Corporation
  • Primoz Petric National Center for Cancer Care and Research, Hamad Medical Corporation

Abstract

Abstract

Background and aim: During radiotherapy of left-sided breast cancer, parts of the heart are irradiated, which may lead to late toxicity. We report on our experience with cardiac-sparing radiotherapy using voluntary deep inspiration breath hold (V-DIBH) and compare its dosimetric outcome with free breathing (FB) technique.

Materials and Methods:  Left-sided breast cancer patients, treated at our department with postoperative radiotherapy between May 2015 and January 2017, were considered for inclusion. FB-computed tomography (CT) was obtained and dose-planning performed. Cases with cardiac V25Gy ≥ 5% or risk factors for heart disease were coached for V-DIBH. Compliant patients were included. They underwent additional CT in V-DIBH for planning, followed by V-DIBH radiotherapy. Dose volume histogram parameters for heart, lung and optimized planning target volume (OPTV) were compared between FB and BH. Treatment setup shifts and systematic and random errors for V-DIBH technique were compared with FB historic control.

Results: Sixty-three patients were considered for V-DIBH. Nine (14.3 %) were non-compliant at coaching, leaving 54 cases for analysis. When compared with FB, V-DIBH resulted in a significant reduction of mean cardiac dose from 6.0 +/- 2.1 to 3.0 +/- 1.1 Gy (p<0.001), maximum cardiac dose from 51.4 +/- 2.0 to 49.1 +/- 5.6 Gy (p=0.005) and cardiac V25Gy from 8.8 +/- 4.2 to 3.1 +/- 2.2 % (p<0.001). Heart volumes receiving low (10 – 20 Gy) and high (30 – 50 Gy) doses were also significantly reduced. Differences between FB- and V-DIBH-derived mean lung dose (9.5 +/- 2.0 vs. 9.5 +/- 2.0 Gy), lung V20Gy (16.8 +/- 4.2 vs. 14.7 +/- 4.9 Gy) and V95% for the OPTV (95.6 +/- 4.1 vs. 95.2 +/- 6.3 %) were non-significant. V-DIBH-derived mean shifts for initial patient setup were ≤ 2.7 mm. Random and systematic errors were ≤ 2.1 mm. These results did not differ significantly from historic FB controls.

Conclusion: When compared with FB, V-DIBH demonstrated high setup accuracy and enabled significant reduction of cardiac doses without compromising the target volume coverage. Differences in lung doses were non-significant.

Author Biographies

Noora Al-Hammadi, National Center for Cancer Care and Research, Hamad Medical Corporation
MD, Assist. prof. Department of Radiation Oncology
Palmira Caparrotti, National Center for Cancer Care and Research, Hamad Medical Corporation
MD, Department of Radiation Oncology
Carole Naim, National Center for Cancer Care and Research, Hamad Medical Corporation
Department of Radiation Oncology
Jillian Hayes, National Center for Cancer Care and Research, Hamad Medical Corporation
Department of Radiation Oncology
Katherine Rebecca Benson, National Center for Cancer Care and Research, Hamad Medical Corporation
Department of Radiation Oncology
Ana Vasic, National Center for Cancer Care and Research, Hamad Medical Corporation
Department of Radiation Oncology
Hissa Al-Abdulla, National Center for Cancer Care and Research, Hamad Medical Corporation
MD, Department of Radiation Oncology
Rabih Hammoud, National Center for Cancer Care and Research, Hamad Medical Corporation
Department of Radiation Oncology
Saju Divakar, National Center for Cancer Care and Research, Hamad Medical Corporation
MD, Department of Radiation Oncology
Primoz Petric, National Center for Cancer Care and Research, Hamad Medical Corporation
MD, PhD, Department of Radiation Oncology
Published
2018-02-21
How to Cite
Al-Hammadi, N., Caparrotti, P., Naim, C., Hayes, J., Benson, K. R., Vasic, A., Al-Abdulla, H., Hammoud, R., Divakar, S., & Petric, P. (2018). Voluntary deep inspiration breath-hold reduces the heart dose without compromising the target volume coverage during radiotherapy for left-sided breast cancer. Radiology and Oncology, 52(1). Retrieved from https://radioloncol.com/index.php/ro/article/view/2949
Section
Clinical oncology