1. DIBH reduces right coronary artery and lung radiation dose in right breast cancer loco-regional radiotherapy.
- Author
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Gough E, Ashworth S, Moodie T, Wang W, Byth K, Beldham-Collins R, Buck J, Ghattas S, Burke L, and Stuart KE
- Subjects
- Humans, Female, Middle Aged, Retrospective Studies, Radiotherapy Planning, Computer-Assisted methods, Aged, Unilateral Breast Neoplasms radiotherapy, Coronary Vessels radiation effects, Organs at Risk, Breast Neoplasms radiotherapy, Breath Holding, Lung radiation effects, Radiotherapy Dosage
- Abstract
To determine whether deep inspiratory breath-hold (DIBH) reduces dose to organs-at-risk (OAR), in particular the right coronary artery (RCA), in women with breast cancer requiring right-sided post-mastectomy radiotherapy (PMRT) including internal mammary chain (+IMC) radiotherapy (RT). Fourteen consecutive women requiring right-sided PMRT + IMC were retrospectively identified. Nodal delineation was in accordance with European Society for Radiology and Oncology (ESTRO) guidelines and tangential chest wall fields marked. Patients were planned with Anisotropic Analytical Algorithm using free-breathing (FB) and DIBH datasets. Dose was calculated using Acuros External Beam algorithm. FB and DIBH dose comparisons were analyzed for heart, RCA and right lung, as were chest wall and IMC planning target volumes (PTVs). DIBH vs FB resulted in median decreases of: the RCA mean dose by 0.6Gray (Gy) (interquartile range (IQR) 0.1, 1.9) (p = 0.002), RCA max dose by 1.8Gy (IQR 0.8, 6.1) (p = 0.002), and V5Gy by 2.9% (IQR 0.0, 37.2) (p = 0.016). RCA data indicated no statistically significant dosimetric reduction ≥10Gy. A median reduction of 1.7Gy (c -0.0, 7.1) (p = 0.019) in maximum heart dose was recorded with DIBH vs FB; no significant difference was observed in other heart and left anterior descending coronary artery parameters. The median reduction in right lung mean dose was 2.8Gy for DIBH vs FB plans (IQR 1.6, 3.6) (p = 0.001); significant median reductions of V5Gy, V20Gy, and V30Gy were all achieved with DIBH. Chest wall PTV coverage did not significantly differ between DIBH and FB plans; IMC dosimetric coverage improved with use of DIBH (V47.5Gy, V45Gy, V42Gy). DIBH reduced OAR dose in right-sided PMRT + IMC patients. A novel finding was that DIBH decreased RCA dose. Heart and right lung dose were also decreased with DIBH, whilst optimally dosed PTVs were maintained., Competing Interests: Conflicts of interest Westmead Hospital paid for the virtual attendance of both the first and last authors to attend the 2020 ESTRO Annual Meeting to present these data (Electronic Poster). Any costs related to submission of manuscript funded by the Sydney West Cancer Network Radiation Oncology Trust Fund, Westmead Hospital (Public Hospital)., (Crown Copyright © 2024. Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
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