Resource requirements and reduction in cardiac mortality from deep inspiration breath hold (DIBH) radiotherapy for left sided breast cancer patients: A prospective service development analysis

Publication date: Available online 21 March 2018
Source:Practical Radiation Oncology
Author(s): Sanjoy Chatterjee, Santam Chakraborty, Arunsingh Moses, Chandran Nallathambi, Anurupa Mahata, Samar Mandal, Rimpa Basu Achari, Indranil Mallick, Raj Kumar Shrimali, Tapesh Bhattacharyya, Sanjit Agrawal, Joydeep Ghosh, Rosina Ahmed
IntroductionUse of Deep Inspiration Breath Hold (DIBH) radiotherapy may reduce long-term cardiac mortality. The resource and time commitments associated with DIBH are impediments to its widespread adoption. We report the dosimetric benefits, workforce requirements and potential reduction in cardiac mortality when DIBH is used for left-sided breast cancers.MethodsData regarding the time consumed for planning and treating 50 patients with left-sided breast cancer with DIBH and 20 patients treated with free breathing (FB) radiotherapy were compiled prospectively for all personnel (regarding person-hours, PH). A second plan was generated for all DIBH patients in the FB planning scan, which was then compared to the DIBH plan. Mortality reduction due to use of DIBH was calculated using the years of life lost (YLLs) due to Ischemic Heart Disease (IHD) for Indians and the postulated reduction in risk of major cardiac events due to reduced cardiac dose.ResultsThe median reduction in mean heart dose (MHD) between the DIBH and FB plans was 166.7cGy (IQR: 62.7–257.4cGy). An extra 6.76 PH was required when implementing DIBH as compared to FB treatments. Approximately 3.57 PH were necessary per Gy of reduction in mean heart dose. The excess YLLs due to IHD if DIBH was not done in was 0.95 per 100 patients, which translates into a saving of 12.8hours of life saved per PH of work required for implementing DIBH. DIBH was cost effective with cost for implementation of DIBH for all left sided breast cancers at 2.3 times the annual per-capita GDP.ConclusionAlthough routine implementation of DIBH requires significant resource commitments, it seems to be worthwhile regarding the projected reductions in cardiac mortality.



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