Deep inspiration breath hold to reduce irradiated heart volume in breast cancer patients

Purpose: To evaluate the use of deep inspiration breath hold (DIBH) during tangential breast radiation therapy as a means of reducing irradiated cardi ac volume. Methods and Materials: The Active Breathing Control (ABC) device designed a t William Beaumont Hospital, Michigan was used to quantify the potential be nefit of radiation delivery during DIBH for five left-sided breast cancer p atients, This device initiates a breath hold at a predefined, reproducible lung volume. For each patient, two CT scans were acquired with and without breath hold, and virtual simulation was performed for regular tangent and w ide-tangent techniques. The resulting dose-volume histograms were calculate d, and the volume of heart irradiated to 25 Gy or more was assessed. Results: The influence of ABC on irradiated heart volumes varied considerab ly among the five patients. Three patients with substantial cardiac volume in the treatment field during normal respiration showed a significant dose- volume histogram reduction when deep inspiration was applied, with decrease s in the heart volume receiving 25 Gy of more than 40 cc observed. For one patient, deep inspiration reduced irradiated cardiac volumes only with the wide-tangent technique, while one patient showed no substantial irradiated volume decrease. Conclusion: A DIBH technique during tangential breast irradiation has the p otential to significantly decrease irradiated cardiac volume for suitably s elected patients. The magnitude of the impact of the breath hold applicatio n depends on patient anatomy, lung capacity, and pulmonary function. (C) 20 01 Elsevier Science Inc.