Dosimetric evaluation of critical organs at risk in mastectomized left-sided breast cancer radiotherapy using breath-hold technique.

AIMS AND BACKGROUND The aim of the study was to evaluate the dosimetric impact of the active breathing control-moderate deep inspiration breath-hold (ABC-mDIBH) technique on normal tissue sparing in locally advanced left-sided breast cancer radiotherapy. METHODS AND STUDY DESIGN Twenty-seven consecutive patients with left-sided locally advanced breast cancer referred to our department for adjuvant radiotherapy were enrolled in the study. Each patient was scanned at free breathing and ABC-mDIBH for radiation treatment planning. Two separate radiotherapy treatment plans were generated with and without ABC-mDIBH to investigate the dosimetric impact of ABC-mDIBH in breast cancer radiotherapy. RESULTS Between June 2011 and February 2012, 27 consecutive patients with left-sided locally advanced breast cancer referred to our department for adjuvant radiotherapy were enrolled in the study. Dose-volume parameters of left anterior descending coronary artery, lungs, heart, contralateral breast, esophagus and spinal cord were significantly reduced with the use of ABC-mDIBH (P <0.001). CONCLUSIONS Our study revealed that the use of ABC-mDIBH in the practice of locally advanced mastectomized left-sided breast cancer radiotherapy improves normal tissue sparing with the expected potential of decreasing treatment-related morbidity and mortality. Moreover, the resultant reduction achieved with ABC in doses to the left anterior descending coronary artery, which plays a central role in cardiac perfusion, may have implications for decreasing the potential of radiation-induced cardiac morbidity and mortality.