Deep inspiration breath hold to reduce irradiated heart volume in breast cancer patients.

PURPOSE: To evaluate the use of deep inspiration breath hold (DIBH) during tangential breast radiation therapy as a means of reducing irradiated cardiac volume. METHODS AND MATERIALS: The Active Breathing Control (ABC) device designed at William Beaumont Hospital, Michigan was used to quantify the potential benefit of radiation delivery during DIBH for five left-sided breast cancer patients. This device initiates a breath hold at a predefined, reproducible lung volume. For each patient, two CT scans were acquired with and without breath hold, and virtual simulation was performed for regular tangent and wide-tangent techniques. The resulting dose-volume histograms were calculated, and the volume of heart irradiated to 25 Gy or more was assessed.
RESULTS: The influence of ABC on irradiated heart volumes varied considerably among the five patients. Three patients with substantial cardiac volume in the treatment field during normal respiration showed a significant dose-volume histogram reduction when deep inspiration was applied, with decreases in the heart volume receiving 25 Gy of more than 40 cc observed. For one patient, deep inspiration reduced irradiated cardiac volumes only with the wide-tangent technique, while one patient showed no substantial irradiated volume decrease.
CONCLUSION: A DIBH technique during tangential breast irradiation has the potential to significantly decrease irradiated cardiac volume for suitably selected patients. The magnitude of the impact of the breath hold application depends on patient anatomy, lung capacity, and pulmonary function.