Deep inspiration breath-hold radiation therapy in left-sided breast cancer patients: a single-institution retrospective dosimetric analysis of organs at risk doses

• Published in: Strahlentherapie und Onkologie 2023-04, Vol.199 (4), p.379-388
• Main Authors: Wolf, Jule, Stoller, Sabine, Lübke, Jördis, Rothe, Thomas, Serpa, Marco, Scholber, Jutta, Zamboglou, Constantinos, Gkika, Eleni, Baltas, Dimos, Juhasz-Böss, Ingolf, Verma, Vivek, Krug, David, Grosu, Anca-Ligia, Nicolay, Nils H., Sprave, Tanja
• Format: Article
• Language: English
• Subjects: Breast cancer; Breast Neoplasms - radiotherapy; Breath Holding; Breathing; Cancer therapies; Catalysts; Computed tomography; Dosimetry; Female; Heart - diagnostic imaging; Heart - radiation effects; Humans; Inspiration; Irradiation; Lungs; Mastectomy; Medicine; Medicine & Public Health; Oncology; Organs at Risk - radiation effects; Original; Original Article; Parameters; Radiation; Radiation therapy; Radiotherapy; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted - methods; Retrospective Studies; Unilateral Breast Neoplasms - radiotherapy; Unilateral Breast Neoplasms - surgery
• ISSN: 0179-7158; 1439-099X
• DOI: 10.1007/s00066-022-01998-z

Background Radiotherapy can induce cardiac injury in left-sided breast cancer cases. Cardiac-sparing irradiation using the deep inspiration breath-hold (DIBH) technique can achieve substantial dose reduction to vulnerable cardiac substructures compared with free breathing (FB). This study evaluated the dosimetric differences between both techniques at a single institution. Methods From 2017 to 2019, 130 patients with left-sided breast cancer underwent breast-conserving surgery (BCS; n  = 121, 93.1%) or mastectomy (ME; n  = 9, 6.9%) along with axillary lymph node staging ( n  = 105, 80.8%), followed by adjuvant irradiation in DIBH technique; adjuvant systemic therapy was included if applicable. 106 (81.5%) patients received conventional and 24 (18.5%) hypofractionated irradiation. Additionally, 12 patients received regional nodal irradiation. Computed tomography (CT) scans in FB and DIBH position were performed for all patients. Intrafractional 3D position monitoring of the patient surface in deep inspiration and breath gating was performed using Sentinel and Catalyst HD 3D surface scanning systems (C-RAD, Catalyst, C‑RAD AB, Uppsala, Sweden). Individual coaching and determination of breathing amplitude during the radiation planning CT was performed. Three-dimensional treatment planning was performed using standard tangential treatment portals (6 or 18 MV). The delineation of cardiac structures and both lungs was done in both the FB and the DIBH scan. Results All dosimetric parameters for cardiac structures were significantly reduced ( p