Deep Inspiration Breath Hold Reduces Dose to the Left Ventricle and Proximal Left Anterior Descending Artery during Radiotherapy for Left-Sided Breast Cancers

Abstract

The purpose of this study was to analyze motion of the left anterior descending coronary artery (LAD) and left ventricle during normal breathing and deep inspiration breath hold (DIBH). This is a dosimetric study utilizing free-breathing and static DIBH scans from eleven patients treated with radiotherapy for breast cancer. The anterior-posterior displacement along the length of the LAD was measured in each respiratory phase. Standard treatment plans targeting the whole breast without treatment of the internal mammary lymph nodes were generated and dose to the LAD and LV calculated. Non-uniform movement of the LAD during respiratory maneuvers with the proximal third exhibiting the greatest displacement was observed. In DIBH compared to end-expiration (EP), the mean posterior displacement of the proximal 1/3 of the LAD was 8.99 mm, the middle 1/3 of the artery was 6.37 mm, and the distal 1/3 was 3.27 mm. In end-inspiration (IP) compared to end-expiration the mean posterior displacements of the proximal 1/3 of the LAD was 2.08 mm, the middle 1/3 of the artery was 0.91 mm, and the distal 1/3 was 0.97 mm. Mean doses to the LAD using tangential treatment fields and a prescribed dose of 50.4 Gy were 11.32 Gy in EP, 8.98 Gy in IP, and 3.50 Gy in DIBH. Mean doses to the LV were 2.38 Gy in EP, 2.31 Gy in IP, and 1.24 Gy in DIBH. In conclusion, inspiration and especially DIBH, cause a displacement of the origin and proximal 2/3 of the LAD away from the chest wall, resulting in sparing of the most critical segment of the artery during tangential radiotherapy.

Share and Cite:

L. A. Jarvis, P. G. Maxim and K. C. Horst, "Deep Inspiration Breath Hold Reduces Dose to the Left Ventricle and Proximal Left Anterior Descending Artery during Radiotherapy for Left-Sided Breast Cancers," Journal of Cancer Therapy, Vol. 3 No. 5A, 2012, pp. 673-679. doi: 10.4236/jct.2012.325087.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] Early Breast Cancer Trialists’ Collaborative Group, “Effects of Radiotherapy and Surgery in Early Breast Cancer. An Overview of the Randomized Trials,” The New England Journal of Medicine, Vol. 333, No. 22, 1995, pp. 1444-1455. doi:10.1056/NEJM199511303332202
[2] M. Clarke, R. Collins, S. Darby, C. Davies, P. Elphinstone, et al., “Effects of Radiotherapy and of Differences in the Extent of Surgery for Early Breast Cancer on Local Recurrence and 15-Year Survival: An Overview of the Randomised Trials,” Lancet, Vol. 366, No. 9503, 2005, pp. 2087-2106.
[3] C. R. Correa, H. I. Litt, W. T. Hwang, V. A. Ferrari, L. J. Solin, et al., “Coronary Artery Findings after Left-Sided Compared with Right-Sided Radiation Treatment for Early-Stage Breast Cancer,” Journal of Clinical Oncology, Vol. 25, No. 21, 2007, pp. 3031-3037.doi:10.1200/JCO.2006.08.6595
[4] E. E. Harris, C. Correa, W. T. Hwang, J. Liao, H. I. Litt, et al., “Late Cardiac Mortality and Morbidity in Early-Stage Breast Cancer Patients after Breast-Conservation Treatment,” Journal of Clinical Oncology, Vol. 24, No. 25, 2006, pp. 4100-4106. doi:10.1200/JCO.2005.05.1037
[5] E. A. Krueger, M. J. Schipper, T. Koelling, R. B. Marsh, J. B. Butler, et al., “Cardiac Chamber and Coronary Artery Doses Associated with Postmastectomy Radiotherapy Techniques to the Chest Wall and Regional Nodes,” International Journal of Radiation Oncology, Biology and Physics, Vol. 60, No. 4, 2004, pp. 1195-1203.doi:10.1016/j.ijrobp.2004.04.026
[6] V. M. Remouchamps, F. A. Vicini, M. B. Sharpe, L. L. Kestin, A. A. Martinez, et al., “Significant Reductions in Heart and Lung Doses Using Deep Inspiration Breath Hold with Active Breathing Control and Intensity- Modulated Radiation Therapy for Patients Treated with Locoregional Breast Irradiation,” International Journal of Radiation Oncology, Biology and Physics, Vol. 55, No. 2, 2003, pp. 392-406. doi:10.1016/S0360-3016(02)04143-3
[7] S. S. Korreman, A. N. Pedersen, L. R. Aarup, T. J. Nottrup, L. Specht, et al., “Reduction of Cardiac and Pulmonary Complication Probabilities after Breathing Adapted Radiotherapy for Breast Cancer,” International Journal of Radiation Oncology, Biology and Physics, Vol. 65, No. 5, 2006, pp. 1375-1380.doi:10.1016/j.ijrobp.2006.03.046
[8] S. S. Korreman, A. N. Pedersen, T. J. Nottrup, L. Specht, and H. Nystrom, “Breathing Adapted Radiotherapy for Breast Cancer: Comparison of Free Breathing Gating with the Breath-Hold Technique,” Radiotherapy & Oncology, Vol. 76, No. 3, 2005, pp. 311-318. doi:10.1016/j.radonc.2005.07.009
[9] L. B. Marks, X. Yu, R. G. Prosnitz, S. M. Zhou, P. H. Hardenbergh, et al., “The Incidence and Functional Con- sequences of RT-Associated Cardiac Perfusion Defects,” International Journal of Radiation Oncology, Biology and Physics, Vol. 63, No. 1, 2005, pp. 214-223.doi:10.1016/j.ijrobp.2005.01.029
[10] E. S. Evans, R. G. Prosnitz, X. Yu, S. M. Zhou, D. R. Hollis, et al., “Impact of Patient-Specific Factors, Irradiated Left Ventricular Volume, and Treatment Set-Up Errors on the Development of Myocardial Perfusion Defects after Radiation Therapy for Left-Sided Breast Cancer,” International Journal of Radiation Oncology, Biology and Physics, Vol. 66, No. 4, 2006, pp. 1125-1134.doi:10.1016/j.ijrobp.2006.06.025
[11] T. Pan, T. Y. Lee, E. Rietzel and G. T. Chen, “4D-CT Imaging of a Volume Influenced by Respiratory Motion On Multi-Slice CT,” Medical Physics, Vol. 31, No. 2, 2004, pp. 333-340. doi:10.1118/1.1639993
[12] S. H. Giordano, Y. F. Kuo, J. L. Freeman, T. A. Buchholz, G. N. Hortobagyi, et al., “Risk of Cardiac Death after Adjuvant Radiotherapy for Breast Cancer,” Journal of the National Cancer Institute, Vol. 97, No. 6, 2005, pp. 419-424. doi:10.1093/jnci/dji067
[13] L. F. Paszat, W. J. Mackillop, P. A. Groome, K. Schulze and E. Holowaty, “Mortality from Myocardial Infarction following Postlumpectomy Radiotherapy for Breast Cancer: A Population-Based Study in Ontario, Canada,” International Journal of Radiation Oncology, Biology and Physics, Vol. 43, No. 4, 1999, pp. 755-762.doi:10.1016/S0360-3016(98)00412-X
[14] P. H. Hardenbergh, M. T. Munley, G. C. Bentel, R. Kedem, S. Borges-Neto, et al., “Cardiac Perfusion Changes in Patients Treated for Breast Cancer with Radiation Therapy and Doxorubicin: Preliminary Results,” International Journal of Radiation Oncology, Biology and Physics, Vol. 49, No. 4, 2001, pp. 1023-1028.doi:10.1016/S0360-3016(00)01531-5
[15] X. Yu, R. R. Prosnitz, S. Zhou, P. H. Hardenberg, A. Tisch, et al., “Symptomatic Cardiac Events following Radiation Therapy for Left-Sided Breast Cancer: Possible Association with Radiation Therapy-Induced Changes in Regional Perfusion,” Clinical Breast Cancer, Vol. 4, No. 3, 2003, pp. 193-197.
[16] P. A. Lind, R. Pagnanelli, L. B. Marks, S. Borges-Neto, C. Hu, et al., “Myocardial Perfusion Changes in Patients Irradiated for Left-Sided Breast Cancer and Correlation with Coronary Artery Distribution,” International Journal of Radiation Oncology, Biology and Physics, Vol. 55, No. 4, 2003, pp. 914-920.doi:10.1016/S0360-3016(02)04156-1
[17] K. S. I. J. Campbell, J. S. Douglas, Jr. and J. M. Bradford, “Prevalence and Distribution of Disease in Patients Catheterized for Suspected Coronary Disease,” McGraw-Hill, New York, 1985.
[18] V. M. Remouchamps, N. Letts, F. A. Vicini, M. B. Sharpe, L. L. Kestin, et al., “Initial Clinical Experience with Moderate Deep-Inspiration Breath Hold Using an Active Breathing Control Device in the Treatment of Patients with Left-Sided Breast Cancer Using External Beam Radiation Therapy,” International Journal of Radiation Oncology, Biology and Physics, Vol. 56, No. 3, 2003, pp. 704-715. doi:10.1016/S0360-3016(03)00010-5

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.