Skip Navigation LinksHome > February 2013 - Volume 36 - Issue 1 > Six-year Experience Routinely Using Moderate Deep Inspiratio...
American Journal of Clinical Oncology:
doi: 10.1097/COC.0b013e31823fe481
Original Articles: Breast

Six-year Experience Routinely Using Moderate Deep Inspiration Breath-hold for the Reduction of Cardiac Dose in Left-sided Breast Irradiation for Patients With Early-stage or Locally Advanced Breast Cancer

Swanson, Todd MD, PhD*; Grills, Inga S. MD; Ye, Hong MS, MPH; Entwistle, Amy BS; Teahan, Melanie BS; Letts, Nicola BS; Yan, Di PhD; Duquette, Joana BSN; Vicini, Frank A. MD

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Abstract

Purpose: Moderate deep inspiration breath-hold (mDIBH), using an Active Breathing Control device, has been used in our clinic since 2002 to reduce cardiac dose for patients receiving left-sided breast irradiation. We report our routine use of the mDIBH technique in clinically localized breast cancer, treated to the intact breast, reconstructed breast, or chest wall.

Materials and Methods: Ninety-nine patients with left-sided breast cancer were evaluated for Active Breathing Control treatment, of which, 87 patients were treated with mDIBH. Plans for both the free-breathing (FB) and mDIBH computed tomography scans were evaluated. Dose-volume histograms (DVHs) were analyzed for the heart and ipsilateral lung, comparing results for mDIBH versus FB plans.

Results: Eighty-seven patients were included for analysis. Of those, 66% received adjuvant chemotherapy with cardiotoxic agents. The mean dose for the whole breast was 47.6 Gy. There was a statistically significant decrease in all DVH parameters evaluated, favoring the delivery of mDIBH over FB plans. mDIBH plans significantly reduced cardiac mean dose (4.23 vs. 2.54 Gy; P<0.001), a relative reduction of 40%. In addition, there were significant reductions in all other heart parameters evaluated (ie, volume of heart treated, V30, V25, V20, V15, V10, and V5). mDIBH also significantly reduced lung dose, including a reduction of the left lung mean dose (9.08 vs. 7.86 Gy; P<0.001), a relative reduction of 13%, as well as significant reduction of all lung DVH parameters evaluated.

Conclusions: To date, this series represents the largest experience utilizing mDIBH to reduce cardiac irradiation during left-sided breast cancer treatment. Statistically significant reductions in all heart and lung DVH parameters were achieved with mDIBH over FB plans. mDIBH, for the treatment of left-sided breast cancer, is a proven technique for reducing cardiac dose that may lead to reduced cardiotoxicity and can be routinely integrated into the clinic.

© 2013 by Lippincott Williams & Wilkins, Inc

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