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CC BY-NC-ND 4.0 · South Asian J Cancer
DOI: 10.1055/s-0044-1786880
Original Article

A Prospective Study on the Use of Deep Inspiration Breath-Hold Technique in External Beam Radiotherapy for Breast Cancer

Nijo Jose   *
1   Department of Radiotherapy and Oncology, Manipal Comprehensive Cancer Care Center, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
,
Jayashree N.P 
1   Department of Radiotherapy and Oncology, Manipal Comprehensive Cancer Care Center, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
,
Shirley Lewis    *
1   Department of Radiotherapy and Oncology, Manipal Comprehensive Cancer Care Center, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
,
Krishna Sharan
1   Department of Radiotherapy and Oncology, Manipal Comprehensive Cancer Care Center, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
,
Umesh Velu
1   Department of Radiotherapy and Oncology, Manipal Comprehensive Cancer Care Center, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
,
Anusha Reddy
1   Department of Radiotherapy and Oncology, Manipal Comprehensive Cancer Care Center, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
,
Anshul Singh
1   Department of Radiotherapy and Oncology, Manipal Comprehensive Cancer Care Center, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
,
Shreekripa Rao
2   Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
,
Shambhavi C.
2   Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
,
Rachel Nisha
2   Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
,
Sarath Nair
3   Department of Radiotherapy and Oncology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
,
Jyothi Nagesh
3   Department of Radiotherapy and Oncology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
,
Srinidhi Chandraguthi 
3   Department of Radiotherapy and Oncology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
› Author Affiliations Funding None.
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Abstract

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Jayashree N. P.

Background Breast cancer is the most common cancer and the leading cause of death in women. The deep inspiration breath-hold (DIBH) technique helps reduce the dose received by the heart and lungs in breast cancers during adjuvant radiotherapy (RT). We present the dosimetry of heart and lungs with DIBH technique, reproducibility, and ease of execution.

Materials and Methods This is a prospective study among breast cancer patients planned for adjuvant RT following either breast conservation or mastectomy. Patients received adjuvant RT to a dose of 42.5 Gy/16 Fr to the chest wall/whole breast followed by a boost of 10 Gy/5 Fr for breast conservation surgery patients with either three-dimensional conformal RT or volumetric modulated arc therapy technique. The dosimetric parameters such as lung mean dose, heart mean dose, and V25 Gy were compared between DIBH and free-breathing (FB) scans. Data were analyzed using SPSS software, and p-value <0.05 was considered statistically significant.

Results The study was conducted from September 2018 to August 2020, and 32 patients were included. The compliance to the DIBH technique was good. The dose received by ipsilateral lung V20 (17 vs. 25%) and mean dose (9 vs. 12 Gy) were significantly lower in DIBH compared with FB (p < 0.001). The V5 (31 vs. 15%), V25 (9 vs. 2%), and mean dose (7 vs. 3.3 Gy) to the heart were much higher in FB compared with DIBH (p < 0.001).

Conclusion DIBH-based RT treatment delivery for breast cancer patients requiring adjuvant RT showed good compliance and offers a significant reduction in radiation dose to the heart and lung.

Keywords

breast cancer - adjuvant radiotherapy - deep inspiration breath hold - radiation - toxicities

Authors' Contribution

There is equal contribution from both first authors hence, put as first coauthors. As well as, equal contribution from both corresponding authors, hence as corresponding coauthors. N.J. and K.S. conceptualized, designed, and analyzed the study. J.N.P. and S.L. prepared the manuscript. All authors reviewed the manuscript.


Note

This study was performed in line with the Declaration of Helsinki; approval was obtained from the Institutional Ethics Committee (IEC no.: 632/2018).


Conference Presentations

WALTCON 2023.


Informed Consent

Informed consent was taken from the participants for participation in the study.


* These authors are the first coauthors.




Publication History

Received: 11 November 2023

Accepted: 16 April 2024

Article published online:
13 May 2024

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