PMID- 37284707
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230608
IS  - 2227-684X (Print)
IS  - 2227-8575 (Electronic)
IS  - 2227-684X (Linking)
VI  - 12
IP  - 5
DP  - 2023 May 30
TI  - Cardiac exposure in left-sided breast cancer patients undergoing deep inspiratory 
      breath hold radiation therapy.
PG  - 677-686
LID - 10.21037/gs-23-160 [doi]
AB  - BACKGROUND: Left-sided breast cancer (BC) patients undergoing post-operative 
      radiation therapy (PRT) may have higher risk of late cardiovascular toxicity, 
      which may be reduced by hearth-sparing RT techniques. This study evaluated 
      dosimetric parameters of the deep inspiration breath hold (DIBH) compared to free 
      breathing (FB) RT. We analysed factors impacting on doses to the heart and 
      cardiac substructures and sought anatomic factors allowing patient selection for 
      DIBH. METHODS: The study group included 67 left-sided BC patients who underwent 
      RT after breast-conserving surgery or mastectomy. Patients treated with DIBH were 
      trained to hold their breath. Computed tomography (CT) scans were performed in 
      both FB and DIBH patients. Plans were generated using 3-dimensional (3D) 
      conformal RT. The dosimetric variables were obtained from dose-volume histograms, 
      and the anatomical variables were derived from the CT scans. The variables in the 
      two groups were compared by t-test, the U test, and the chi-squared test. 
      Correlation analysis was performed using Pearson's correlation coefficient. 
      Receiver operating characteristic curves were used to analyze the efficacy of the 
      predictors. RESULTS: Compared to the FB, DIBH allowed for a mean dose reduction 
      to the heart, left anterior descending coronary artery (LAD), left ventricle 
      (LV), and right ventricle (RV) by 30.0%, 38.7%, 39.3%, and 34.7%, respectively. 
      DIBH markedly increased the heart height (HH), heart chest wall distance (HCWD), 
      the mean distance between the ipsilateral lung and breast (DBIB), and decreased 
      the heart-chest wall length (HCWL) (P<0.05). The different value of HH, DBIB, 
      HCWL, and HCWD between DIBH and FB were 1.31, 1.95, -0.67, and 0.22 cm, 
      respectively (all P<0.05). DeltaHH was an independent predictor of the mean dose to 
      the heart, LAD, LV, and RV, with the area under the curve values of 0.818, 0.725, 
      0.821, and 0.820, respectively. CONCLUSIONS: DIBH significantly reduced the dose 
      to the entire heart and its substructures in left-sided BC patients undergoing 
      post-operative RT. DeltaHH predicts the mean dose to the heart and its substructures. 
      These results may inform patient selection for DIBH.
CI  - 2023 Gland Surgery. All rights reserved.
FAU - Zhu, Huijun
AU  - Zhu H
AD  - Department of Radiation Oncology, The Second Affiliated Hospital of Guangxi 
      Medical University, Nanning, China.
FAU - Sun, Huiwen
AU  - Sun H
AD  - Department of Oncology, The Second Affiliated Hospital of Guangxi Medical 
      University, Nanning, China.
FAU - Zhang, Jiaming
AU  - Zhang J
AD  - Department of Radiation Oncology, The Second Affiliated Hospital of Guangxi 
      Medical University, Nanning, China.
FAU - Xie, Yiting
AU  - Xie Y
AD  - Department of Radiation Oncology, The Second Affiliated Hospital of Guangxi 
      Medical University, Nanning, China.
FAU - Jassem, Jacek
AU  - Jassem J
AD  - Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, 
      Poland.
FAU - Franco, Pierfrancesco
AU  - Franco P
AD  - Department of Translational Medicine (DIMET), University of Eastern Piedmont, 
      Novara, Italy.
AD  - Department of Radiation Oncology, 'Maggiore della Carita' University Hospital, 
      Novara, Italy.
FAU - Sun, Weiliang
AU  - Sun W
AD  - Department of Oncology, The Second Affiliated Hospital of Guangxi Medical 
      University, Nanning, China.
FAU - Liu, Wenqi
AU  - Liu W
AD  - Department of Radiation Oncology, The Second Affiliated Hospital of Guangxi 
      Medical University, Nanning, China.
FAU - Yue, Haiying
AU  - Yue H
AD  - Department of Radiation Oncology, The Second Affiliated Hospital of Guangxi 
      Medical University, Nanning, China.
LA  - eng
PT  - Journal Article
DEP - 20230529
PL  - China (Republic : 1949- )
TA  - Gland Surg
JT  - Gland surgery
JID - 101606638
PMC - PMC10240437
OTO - NOTNLM
OT  - Breast cancer (BC)
OT  - deep inspiration breath hold (DIBH)
OT  - heart protection
OT  - radiotherapy
COIS- Conflicts of Interest: All authors have completed the ICMJE uniform disclosure 
      form (available at 
      https://gs.amegroups.com/article/view/10.21037/gs-23-160/coif). The authors have 
      no conflicts of interest to declare.
EDAT- 2023/06/07 13:10
MHDA- 2023/06/07 13:11
PMCR- 2023/05/30
CRDT- 2023/06/07 09:53
PHST- 2023/03/01 00:00 [received]
PHST- 2023/05/16 00:00 [accepted]
PHST- 2023/06/07 13:11 [medline]
PHST- 2023/06/07 13:10 [pubmed]
PHST- 2023/06/07 09:53 [entrez]
PHST- 2023/05/30 00:00 [pmc-release]
AID - gs-12-05-677 [pii]
AID - 10.21037/gs-23-160 [doi]
PST - ppublish
SO  - Gland Surg. 2023 May 30;12(5):677-686. doi: 10.21037/gs-23-160. Epub 2023 May 29.