Deep Inspiration Breath-Hold (DIBH) produces a clinically meaningful reduction in ipsilateral lung dose during loco-regional radiation therapy for some women with right-sided breast cancer

Publication date: Available online 19 October 2016
Source:Practical Radiation Oncology
Author(s): Jessica L. Conway, Leigh Conroy, Lindsay Harper, Marie Scheifele, Haocheng Li, Wendy L. Smith, Tannis Graham, Tien Phan, Ivo A. Olivotto
Background & PurposeTo determine whether Deep Inspiration Breath Hold (DIBH) produced a clinically meaningful reduction in pulmonary dose compared to free breathing (FB) during loco-regional radiation for right-sided breast cancer.Materials & MethodsFour-field, modified-wide tangent plans with full nodal coverage were developed for 30 consecutive patients on paired DIBH and FB CT scans. Nodes were contoured according to ESTRO guidelines. Plan metrics were compared using Wilcoxon signed-rank testing.ResultsTwenty-one patients (70%) had ≥5% reduction in ipsilateral lung V20 with DIBH compared to FB. The mean ipsilateral lung V20 decrease was 7.8% (0 to 20%; p<0.001). The mean lung dose (MLD) decreased on average by 3.4Gy with DIBH (−0.2 to 9.1; p<0.001). The mean reduction in liver volume receiving 50% of the prescribed dose was 42.3cc (0 to 178.9; p<0.001).ConclusionsDIBH reduced the ipsilateral lung V20 by ≥5% for the majority of patients. For some patients, the volume of liver receiving a potentially toxic dose was reduced with DIBH. DIBH should be available as a treatment strategy to reduce ipsilateral lung V20 prior to compromising IMC nodal coverage for patients with right-sided breast cancer during loco-regional RT if the V20 on FB exceeds 30%.



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