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The effect of deep inspiration breath-hold technique on left anterior descending coronary artery and heart dose in left breast irradiation

Radiation Oncology Journal 2020년 38권 3호 p.181 ~ 188
Sakyanun Pitchaya, Saksornchai Kitwadee, Nantavithya Chonnipa, Chakkabat Chakkapong, Shotelersuk Kanjana,
소속 상세정보
 ( Sakyanun Pitchaya ) - Chulalongkorn University Faculty of Medicine Department of Radiology
 ( Saksornchai Kitwadee ) - Chulalongkorn University Faculty of Medicine Department of Radiology
 ( Nantavithya Chonnipa ) - Chulalongkorn University Faculty of Medicine Department of Radiology
 ( Chakkabat Chakkapong ) - Chulalongkorn University Faculty of Medicine Department of Radiology
 ( Shotelersuk Kanjana ) - Chulalongkorn University Faculty of Medicine Department of Radiology

Abstract


Purpose: To determine the effect of the deep inspiration breath-hold (DIBH) technique on left anterior descending coronary artery (LAD) region and heart dose in left breast cancer irradiation.

Materials and Methods: Twenty-five left breast cancer patients who previously received breast-conserving surgery underwent computed tomography (CT) simulation with both free-breathing (FB) and DIBH techniques and four radiation treatment plans. The plan comprised the following with both the FB and DIBH techniques: whole breast (WB), and WB with internal mammary lymph nodes (WB+IMNs). The prescription dose was 50 Gy in 25 fractions. The doses to the LAD region, heart and lungs were compared. Moreover, in-field maximum heart distance (maxHD) and breast volume were analyzed for correlations with the mean heart dose (MHD).

Results: In the WB plan with DIBH vs. FB techniques, the mean radiation doses to the LAD region, MHD, and the left lung V20 were 11.48 Gy vs. 19.84 Gy (p < 0.0001), 2.95 Gy vs. 5.38 Gy (p < 0.0001), and 19.72% vs. 22.73% (p = 0.0045), respectively. In the WB+IMNs plan, the corresponding values were 23.88 Gy vs. 31.98 Gy (p < 0.0001), 6.43 Gy vs. 10.24 Gy (p < 0.0001), and 29.31% vs. 32.1% (p = 0.0009), respectively. MHD correlated with maxHD (r = 0.925) and breast volume (r = 0.6).

Conclusion: The use of the DIBH technique in left breast cancer irradiation effectively reduces the radiation doses to the LAD region, heart and lungs. MHD is associated with maxHD and breast size.

키워드

Breast cancer; Radiation; Coronary vessels; Heart dose; Deep inspiration breath-hold

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