Heart Sparing Radiotherapy Techniques in Breast Cancer: A Focus on Deep Inspiration Breath Hold

Abstract

Adjuvant radiation therapy is a critical component of breast cancer management. However, when breast cancer patients receive incidental radiation to the heart, there is an increased risk of cardiac disease and mortality. This is most common for patients with left-sided breast cancers and those receiving nodal irradiation as part of treatment. The overall risk of cardiac toxicity increases 4–16% with each Gray increase in mean heart radiation dose, with data suggesting that no lower limit exists which would eliminate cardiac risk entirely. Radiation techniques have improved over time, leading to lower cardiac radiation exposure than in the past. This decline is expected to reduce the incidence of radiation-induced heart dysfunction in patients. Deep inspiration breath hold (DIBH) is one such technique that was developed to reduce the risk of cardiac death and coronary events. DIBH is a non-invasive approach that capitalizes on the natural physiology of the respiratory cycle to increase the distance between the heart and the therapeutic target throughout the course of radiation therapy. DIBH has been shown to decrease the mean incidental radiation doses to the heart and left anterior descending coronary artery by approximately 20–70%. In this review, we summarize different techniques for DIBH and discuss recent data on this technique.

SGRT‐based DIBH radiotherapy practice for right‐sided breast cancer combined with RNI: A retrospective study on dosimetry and setup accuracy

“…In this study, the mean cardiac and RCA dose reduction rates by DIBH were 24.0% and 23.1%, respectively. However, DIBH technique in left‐sided breast radiotherapy can reduce the mean dose of the heart and left anterior descending coronary artery (LAD) by 25%−67% and 20%−73%, respectively, 26 with an average reduction of 46% and 46.5%, respectively. In terms of the contribution of DIBH technology to the average reduction rate for heart and RCA, the benefit for right‐sided breast cancer patients is significantly weaker than that for left‐sided breast cancer patients.…”

Krūties Vėžio Radioterapija Taikant Inovatyvų Gilaus Kvėpavimo Kontrolės Metodą: Klinikiniai Vakarų Lietuvoje Sukauptos Patirties Aspektai

“…Praktiškai įdiegus naujas radioterapijos technologijas, atsiveria naujos pacienčių gydymo optimizavimo galimybės, jį individualizuojant (Stowe, 2022). Po krūtį tausojančios operacijos radioterapija rekomenduojama kiekvienai pacientei.…”

“…Moterys po kombinuoto krūties vėžio gydymo gyvena ilgai, tad ypač svarbu, kad po radioterapijos prabėgus dešimtmečiams pacienčių sveikata neblogėtų dėl radiacinės plaučio ar širdies pažaidos Stowe, 2022). Širdies pažaida įvyksta dėl koronarinių kraujagyslių ir kapiliarų pokyčių, kuriuos sukelia progresuojanti fibrozė, vėliau lemianti išeminę širdies ligą.…”

Automated review of patient position in DIBH breast hybrid IMRT with EPID images

“…3 During breast radio-a deep breath before the treatment beam is turned on, pushing the heart away from the path of the beam. 10,11 Cardiac doses have been reported to be significantly lowered with the use of the DIBH technique. 9,[12][13][14][15][16] When performing DIBH, it is important to have a monitoring system in place to ensure the patient's breath hold remains stable and is reproducible at each fraction.Monitoring systems include 3D surface imaging systems, the alignment of lasers to patient skin tattoos, and a marker block placed on the patient's xiphoid process.…”

“…Deep Inspiration Breath Hold (DIBH) has been adopted in breast radiotherapy to lower cardiac irradiation 8,9 . It involves the patient taking in and holding a deep breath before the treatment beam is turned on, pushing the heart away from the path of the beam 10,11 . Cardiac doses have been reported to be significantly lowered with the use of the DIBH technique 9,12–16 .…”