PROSPECTIVE OBSERVATIONAL STUDY OF DEEP INSPIRATION BREATH HOLD (DIBH) IN RADIOTHERAPY FOR LEFT-SIDED BREAST CANCER

Received 2022-01-03; Accepted 2022-03-16; Published 2022-11-23

Authors

  • Ying Ying Sum Clinical Oncology Unit, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
  • Jasmin Pei Yuin Loh Oncology Department, Beacon Hospital, 46050 Petaling Jaya, Selangor, Malaysia.
  • Wei Loong Jong Proton Therapy Pte Ltd, Amnios 138622, Singapore.
  • Zamzarinah Kamarul Zaman Clinical Oncology Unit, University Malaya Medical Centre, 59100 Kuala Lumpur, Malaysia.
  • Adlinda Alip Clinical Oncology Unit, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.

DOI:

https://doi.org/10.22452/jummec.vol25no2.18

Keywords:

DIBH, left breast radiotherapy, FB-CCD, mean heart dose

Abstract

Objective: The objective of this study was to prospectively collect and report treatment planning data in terms of organs at risk (OARs) sparing effect between deep inspiration breath hold (DIBH) and free breathing (FB) computed tomography (CT) scans. This study also aims to identify potential planning parameters that could help in selecting patients most likely to benefit from DIBH.

Methods: Thirty-eight patients with left-sided breast malignancy indicated for adjuvant radiotherapy underwent DIBH and FB CT simulation. All patients were planned with a three-dimensional conformal radiation therapy (3D-CRT) for both scans. Comparisons of dosimetric variables include heart Dmean, left anterior descending coronary artery (LAD) Dmean/Dmax, left lung V30Gy, V20Gy, V10Gy, V5Gy, FB axial cardiac contact distance (FB-CCDax) and parasagittal CCD (FB-CCDps).

Results: DIBH resulted in a statistically significant reduction of heart Dmean, LAD Dmean and Dmax. When DIBH was compared with FB, heart Dmean was 1.62 Gy versus 2.65 Gy; for LAD Dmean, 6.81 Gy versus 11.57 Gy; and for LAD Dmax, 22.66 Gy versus 31.93 Gy. Left lung dosimetry results consistently showed all the volume parameters of V5Gy to V30Gy for FB were significantly higher than that of DIBH. There was a significant positive correlation between FB-CCDax/FB-CCDps and mean heart absolute dose reduction. A meaningful positive correlation was observed for FB-CCDps beyond the cutoff length of 2cm.

Conclusion: Our study has confirmed the benefit of DIBH in reducing mean heart and lung dose in left-sided breast/chest wall radiotherapy. FB-CCDps is a potentially reliable parameter to guide us in selecting patients whom would benefit most for DIBH.

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Published

2022-11-23

Issue

Vol. 25 No. 2 (2022)

Section

Research article

License

All authors agree that the article, if editorially accepted for publication, shall be licensed under the Creative Commons Attribution License 4.0 to allow others to freely access, copy and use research provided the author is correctly attributed, unless otherwise stated. All articles are available online without charge or other barriers to access. However, anyone wishing to reproduce large quantities of an article (250+) should inform the publisher. Any opinion expressed in the articles are those of the authors and do not reflect that of the University of Malaya, 50603 Kuala Lumpur, Malaysia. 

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