Document Type : Original Paper
Dept of Radiation Oncology, ILBS, New Delhi
Dept of Radiation Oncology Max Superspeciality Hospital, Shalimar Bagh ,Delhi
Department of Radiation Oncology, Fortis Superspeciality Hospital, Shalimar Bagh Delhi
Department of Radiation Oncology Max Superspeciality Hospital, Shalimar Bagh ,Delhi
Introduction: Long term cardiac morbidity is a concern with left sided breast/chest wall irradiation. In this present study, we have evaluated the Impact of Voluntary deep inspiratory breath hold (V-DIBH) Vs Free Breathing (FB) technique on heart and lung doses for left-sided breast cancer with audio visual guidance.
Material and Methods: A total of 31 patients diagnosed with left breast cancer were found to be suitable for V-DIBH. Patients were trained for breath hold technique for 3 to 4 days on CT simulator. Seven patients being non-compliant to V-DIBH therefore 24 patients were simulated for breath hold. We made tangential IMRT plans for all the patients on both V-DIBH and free breathing scans for dosimetric comparison. D95% target and organ at risk (OARs) like Dmean of heart, LAD, lung and opposite breast were compared for both plans.
Results: A significant reduction of mean cardiac dose from 5.7 ± 1.58 Gy to 3.45 ± 0.68 Gy (p<.05) and cardiac V25Gy from 7.28 ±3.97 % to 1.64 ± 1.35% (p<.05) in V-DIBH cases as compared to FB. Mean dose to the LAD was reduced by 3.9 Gy in DIBH cases (p<.05). Differences between FB and V-DIBH mean lung dose was 2.47 Gy (p=.106, ns) and ipsilateral lung V20Gy was 2.57% (p=.078, ns).
Conclusion: This study demonstrates dosimetric benefits of V-DIBH over FB in reducing dose to heart, LAD and ipsilateral lung without compromising the target volume coverage. We should opt for V-DIBH over FB for left sided breast cancer cases