A dosimetric study of cardiac dose sparing using the reverse semi-decubitus technique for left breast and internal mammary chain irradiation

Significant reductions in heart and lung doses using semi lateral decubitus techniques for left sided breast cancer patients: A comparative dosimetric study with supine techniques

“…In accordance with the results of the current study Campana, F et al 27 found that breast radiotherapy in the lateral decubitus position reduced lung and heart irradiation over the conventional technique with opposing tangential fields. In contrast to the results of the current study Niglas M et al 7 found no significant reduction for lung V 20Gy or V 5Gy cardiac dose sparing using the reverse semi-decubitus technique for left breast and internal mammary chain irradiation .…”

“…As regard heart sparing; although the current study showed that the semi-lateral decubitus techniques resulted in greater heart sparing compared to supine technique the semi-lateral decubitus and breath hold technique resulted in superior heart sparing compared to supine and semi-lateral decubitus techniques. Niglas M et al 7 found that mean heart dose and heart V 25Gy were significantly lower for both reverse semi lateral decubitus (RSD) and deep inspiration breath hold (mDIBH) when compared to supine technique (P < 0.001 to 0.006). The average values of mean heart dose using these techniques were 10 Gy, 6 Gy and 3.0 Gy respectively.…”

“…Simulation and treating the patients in prone, 5,6 lateral and semi-decubitus positions could also improve cardiac and lung dosimetry. 7,8 Another ways of cardiac sparing are intensity modulated radiotherapy (IMRT) and proton beam radiotherapy. 9 Breath hold reduces the heart dose because the heart volume exposed to radiation is reduced as the heart moves away from the chest wall.…”

“…8 The semi-decubitus (RSD) technique is an alternative method for cardiac and lung sparing for patients who are unable to tolerate breath hold. 7 Computerized leaves of IMRT allow for radiation field shaping and help dose escalation to the target with significant reductions in the cardiac dose. IMRT is successfully used as a class solution for cardiac protection in left sided breast cases especially for patients with large breast.…”

Evaluation of Effect of Inverse and Field-in-Field IMRT Planning for Left-Sided Anterior Descending Coronary Artery Doses in Left-Sided Breast Cancer Patients

“…Prone positions or the semi-decubitus technique have been used to exclude the heart from additional irradiation fields in many patients. [20,21] However, in some author series, incidental dose to the coronary arteries is higher in prone than in supine whole-breast irradiation. [22] Respiratory gating, which means intermittent irradiation synchronous with the free breathing cycle and administered in the supine position, should be further analyzed.…”