Impact of chest wall motion caused by respiration in adjuvant radiotherapy for postoperative breast cancer patients

To determine the chest wall movement of each patient during deep inspiratory breath hold (DIBH) and expiratory breath hold (EBH) in postoperative breast cancer patients. Postoperative breast cancer patients who underwent CT simulation for 3D radiotherapy treatment planning during December 2012 to November 2013 were included. Before scanning the radio-opaque wire was placed on the surface for breast and chest wall visualization on CT images, then the patient underwent three phases of CT scanning (free breathing, DIBH, and EBH, respectively). The distances of chest wall motion at five reference points were calculated using the treatment planning system. 38 breast cancer patients who underwent surgery were included. Median age was 48.5 (28-85) years. Median BMI was 23.4 (16.6-38.3) kg/m(2). Median lung volume was 3160.5 (1830.8-4754.0) cm(3). Median Haller index was 2.43 (1.92-3.56). Median chest wall movement was wider in anteroposterior (A-P, 4.2-5.4 mm) than superoinferior (S-I, 2.5-2.6 mm) and mediolateral (M-L, 0.6-1.1 mm) dimension in all five measured points. There was no significant effect of the type of surgery, BMI, lung volume, and the Haller index on the distances of chest wall movement. Additional margins of 7, 5, and 2 mm to the A-P, S-I, and M-L dimension should adequately cover the extreme chest wall movement in 95 % of the patients. This study showed that the maximal movement of the chest wall during DIBH and EBH was greatest in the A-P axis followed by the S-I axis, while the M-L axis was minimally affected by respiration.