Breast cancerImproved heart, lung and target dose with deep inspiration breath hold in a large clinical series of breast cancer patients
Section snippets
Methods and materials
DIBH is part of the standard RT treatment for post-operative left-sided breast cancer patients in our department. It was introduced in two steps: from September 2010 for patients aged 60 years or less, and from February 2011 onwards DIBH has been the treatment of choice for all left-sided breast cancer patients.
The present study is based on a retrospective collection of dose volume histograms from the first 144 patients treated with DIBH in our clinic during the period from September 2010 to
Results
Main characteristics of the three patient groups can be found in Table 1. In total, 319 patients were included in the analysis, of which 144 were DIBH patients. Left sided breast cancer patients unable to comply with the requirements for DIBH were noted, but not included in the analysis of dose plan metrics; details of this group (20 patients) can be found in Table 2. The two main causes for non-compliance were inability to use the mouthpiece of the ABC equipment and psychological reasons.
The
Discussion
The benefits of post-operative RT for breast cancer patients, in terms of reduced risk of recurrence, have been clearly demonstrated, but concurrent heart irradiation leads to an increased risk of heart disease. At the moment, the dose–response relationship for radiation-induced heart disease remains uncertain [3], and thus the best approach seems to be to avoid direct irradiation of the heart altogether [16]. This, on the other hand, will often lead to lower target coverage for left-sided
Conclusion
From a retrospective analysis of dose plans from 144 left-sided breast cancer patients treated with DIBH we have found that, compared to free-breathing patients, there is a large reduction in heart dose and a smaller reduction in lung dose. This decrease in dose to organs at risk does not come at the cost of decreased target coverage, as we find that median PTV coverage is slightly improved and especially large compromises (with PTV coverage of <95%) are significantly reduced from 17% down to
Conflicts of interest
The authors report no conflicts of interest.
Acknowledgements
A.L.A. is supported by the Region of Southern Denmark and by CIRRO – The Lundbeck Foundation Center for Interventional Research in Radiation Oncology and The Danish Council for Strategic Research. The authors gratefully acknowledge the fruitful discussions with Martin Berg and Ivan R. Vogelius in the preparation of this manuscript.
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