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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

American Journal of Clinical Oncology: February 2013 - Volume 36 - Issue 1 - p 24–30
doi: 10.1097/COC.0b013e31823fe481
Original Articles: Breast

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.

*Department of Radiation Oncology, University of Texas Medical Branch, Galveston, TX

Department of Radiation Oncology, Beaumont Cancer Institute, William Beaumont Hospital, Royal Oak, MI

Supported in part by an Educational Grant from Elekta Oncology Systems, the Alfred Berkowitz Foundation, the William Beaumont Hospital Foundation and the National Cancer Institute (NCI) grant 1R01CA76182.

Presented as an oral presentation at the 2009 ASTRO Annual Meeting, Chicago, IL.

The authors declare no conflicts of interest.

Reprints: Frank A. Vicini, MD, Department of Radiation Oncology, Beaumont Cancer Institute, William Beaumont Hospital, 3601W. 13 Mile Road, Royal Oak, MI 48073. E-mail:

© 2013 by Lippincott Williams & Wilkins, Inc