Selection of patients with left breast cancer for deep-inspiration breath-hold radiotherapy technique: Results of a prospective study

Abstract

Aim

To assess prospectively which patients with left breast cancer have the dosimetric benefit from the use of deep-inspiration breath-hold radiotherapy (DIBH-RT).

Background

Improvement in selection of patients for DIBH-RT would spare time of radiotherapy staff by removing the need for preparation of two comparative treatment plans.

Materials and methods

Thirty-one patients qualified for whole left breast irradiation underwent breath-hold training and their free-breathing (FB) and DIBH planning-CT were included in the analysis of dosimetric outcome. Mean heart dose (MHD), heart V20[[ce:hsp sp="0.25"/]]Gy (V20Heart), maximum dose to LAD (LADmax), V20 for left lung (V20L.lung) were recorded from FB and DIBH plans and the differences (Δ) of these values were calculated. If relative improvement of at least 20% for any evaluated dosimetric parameter was found for the DIBH-RT, this plan was selected for treatment. Correlations of Δ of dosimetric parameters with patient-related parameters (BMI, age, PTV, cardiac contact distance [CCD], lung volume at FB) were sought.

Results

In 30 of 31 patients, a predefined reduction in evaluated parameters was achieved. CCD, BMI correlated positively with ΔMHD, ΔV20Heart, ΔLADmax; PTV with ΔMHD and ΔV20Heart (p[[ce:hsp sp="0.25"/]]<[[ce:hsp sp="0.25"/]]0.05; AUC[[ce:hsp sp="0.25"/]]>[[ce:hsp sp="0.25"/]]0.6); Lung volume correlated negatively with ΔLADmax, ΔMHD and ΔV20Heart. No specific thresholds for the lack of predefined improvement of any dosimetric parameters was identified in ROC analysis. 19/30 (63%) patients with dosimetric benefit completed their RT with DIBH.

Conclusions

Despite a strong correlation between patient-related and dosimetric parameters, we cannot use the anatomical characteristics’ thresholds to select patients for whom DIBH-RT will not be considered.