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Open Access 08-09-2022 | Breast Cancer | Original Article

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

Authors: Jule Wolf, Sabine Stoller, Jördis Lübke, Thomas Rothe, Marco Serpa, Jutta Scholber, Constantinos Zamboglou, Eleni Gkika, Dimos Baltas, Ingolf Juhasz-Böss, Vivek Verma, David Krug, Anca-Ligia Grosu, Nils H. Nicolay, Tanja Sprave, MD MBA

Published in: Strahlentherapie und Onkologie | Issue 4/2023

Abstract

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 < 0.01 for all). The mean heart dose (Dmean) in the DIBH group was 1.3 Gy (range 0.5–3.6) vs. 2.2 Gy (range 0.9–8.8) in the FB group (p < 0.001). The Dmean for the left ventricle (LV) in DIBH was 1.5 Gy (range 0.6–4.5), as compared to 2.8 Gy (1.1–9.5) with FB (p < 0.001). The parameters for LV (V10 Gy, V15 Gy, V20 Gy, V23 Gy, V25 Gy, V30 Gy) were reduced by about 100% (p < 0.001). The LAD Dmean in the DIBH group was 4.1 Gy (range 1.2–33.3) and 14.3 Gy (range 2.4–37.5) in the FB group (p < 0.001). The median values for LAD such as V15 Gy, V20 Gy, V25 Gy, V30 Gy, and V40 Gy decreased by roughly 100% (p < 0.001). An increasing volume of left lung in the DIBH position resulted in dose sparing of cardiac structures.

Conclusion

For all ascertained dosimetric parameters, a significant dose reduction could be achieved in DIBH technique.

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Title: Deep inspiration breath-hold radiation therapy in left-sided breast cancer patients: a single-institution retrospective dosimetric analysis of organs at risk doses
Authors: Jule Wolf
Sabine Stoller
Jördis Lübke
Thomas Rothe
Marco Serpa
Jutta Scholber
Constantinos Zamboglou
Eleni Gkika
Dimos Baltas
Ingolf Juhasz-Böss
Vivek Verma
David Krug
Anca-Ligia Grosu
Nils H. Nicolay
Tanja Sprave, MD MBA
Publication date: 08-09-2022
Publisher: Springer Berlin Heidelberg
Keywords: Breast Cancer
Breast Cancer
Radiotherapy
Published in: Strahlentherapie und Onkologie / Issue 4/2023
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-022-01998-z

At a glance: The STEP trials

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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