Deep inspiration breath-hold (DIBH) radiotherapy in left-sided breast cancer: Dosimetrical comparison and clinical feasibility in 20 patients

Strahlenther Onkol (2015) 191:710716 DOI 10.1007/s00066-015-0838-y

ORIGINAL ARTICLE

Deep inspiration breath-hold (DIBH) radiotherapy in left-sided breast cancer

Dosimetrical comparison and clinical feasibility in 20 patients

Rodrigo Hepp Mark Ammerpohl Christina Morgenstern Lisa Nielinger Patricia Erichsen Abdallah Abdallah Razvan Galalae

Received: 13 November 2014 / Accepted: 25 March 2015 / Published online: 18 April 2015 Springer-Verlag Berlin Heidelberg 2015

Abstract

Background Adjuvant radiotherapy after breast-conserving surgery (BCS) for breast cancer (BC) is a well-established indication. The risk of ischaemic heart disease after radio-therapy for BC increases linearly with the heart mean dose with no apparent threshold. Radiotherapy to the left breast in deep inspiration breath-hold (DIBH) reduces the dose to the heart. A new linac system with an integrated surface scanner (SS) for DIBH treatments was recently installed in our department. We tested it for potential benets, safety, patients acceptance/compliance and associated additional workload.

Materials and methods Twenty consecutive patients following BCS for breast carcinoma of the left side were enrolled in our institutional DIBH protocol. We compared dose to the heart and ipsilateral lung (IL) between plans in DIBH and free breathing (FB) using standard dened parameters: mean dose, maximal dose to a volume of 2 cm3

Dr. med. R. Hepp, M.D. () M. Ammerpohl, M.D. C. Morgenstern, M.Sc. L. Nielinger, B.Eng. P. Erichsen, M.D. R. Galalae, M.D.

Klinik fr Strahlentherapie und Radioonkologie, Evangelische Kliniken Gelsenkirchen,Munckelstrae 27, 45879 Gelsenkirchen, Deutschlande-mail: [e-mail]

L. Nielinger, B.Eng.

Hochschule Hamm-Lippstadt, Lippstadt, Deutschland

A. Abdallah, M.D.

Klinik fr Senologie, Evangelische Kliniken Gelsenkirchen, Gelsenkirchen, Deutschland

R. Galalae, M.D.

Medizinische Fakultt, Christian-Albrechts-Universitt zu Kiel, Kiel, Deutschland

(D2 cm3), volume receiving 5 Gy (V5), 10 Gy (V10), 15 Gy (V15) and 20 Gy (V20). Comparison of median calculated dose values was performed using a two-tailed Wilcoxon signed rank test.

Results DIBH was associated with a statistically signicant reduction (p < 0.001) in all studied parameters for the heart and the IL. In 16 of 20 patients the heart D2 cm3 was less than 42 Gy in DIBH. In FB the heart D2 cm3 was 42 Gy in 17 of 20 patients. The median daily treatment time was 9 min.

Conclusion Radiotherapy of the left breast in DIBH using a SS could easily be incorporated into daily routine and is associated with signicant...