Deep Inspiration Breath Hold Reduces Dose to the Left Ventricle and Proximal Left Anterior Descending Artery
during Radiotherapy for Left-Sided Breast Cancers
678
avoid field overlap s.
In conclusion, treatment of left-sided breast cancers
during end-inspiration or DIBH can substantially reduce
the radiation dose to the left ventricle and left-anterior
descending artery compared to treatment during end-
expiration. In particular, inspiration and especially DIBH
cause a displacement of the origin and proximal 2/3 of
the LAD away from the chest wall, resulting in the po-
tential to decrease radiation dose to the most critical
segment of the artery during tangent field radiotherapy.
In order to minimize a patient’s long-term risk of coro-
nary artery disease and cardiac morbidity, we recom-
mend tailoring the delivery of left-sided breast radio-
therapy to the patient’s anatomy, using a respiratory-
gated CT for evaluation of heart position at baseline and
the amount of displacement with inspiration or DIBH. In
addition to improved 3D treatment planning techniques,
even patients receiving radiotherapy for left-sided breast
cancers without specific targeting of the IMNs may
benefit from the use of respiratory-gated treatments.
5. Conflict of Interest
We certify that regarding this paper, no actual or poten-
tial conflicts of interests exist; the work is original, has
not been accepted for publication nor is concurrently
under consideration elsewhere, and will not be published
elsewhere without the permission of the Editor. All the
authors have contributed directly to the planning, execu-
tion or analysis of the work reported or to the writing of
the paper.
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