Voluntary Breath-hold Technique for Reducing Heart Dose in Left Breast Radiotherapy

Abstract

Breath-holding techniques reduce the amount of radiation received by cardiac structures during tangential-field left breast radiotherapy. With these techniques, patients hold their breath while radiotherapy is delivered, pushing the heart down and away from the radiotherapy field. Despite clear dosimetric benefits, these techniques are not yet in widespread use. One reason for this is that commercially available solutions require specialist equipment, necessitating not only significant capital investment, but often also incurring ongoing costs such as a need for daily disposable mouthpieces. The voluntary breath-hold technique described here does not require any additional specialist equipment. All breathholding techniques require a surrogate to monitor breath-hold consistency and whether breath-hold is maintained. Voluntary breath-hold uses the distance moved by the anterior and lateral reference marks (tattoos) away from the treatment room lasers in breath-hold to monitor consistency at CT-planning and treatment setup. Light fields are then used to monitor breath-hold consistency prior to and during radiotherapy delivery.

Voluntary breath-holding for breast cancer radiotherapy is consistent and stable

“…This VBH technique has been compared to and found equivalent to an ABC breath-hold technique in patients receiving left breast radiotherapy in terms of set-up reproducibility and cardiac dose reduction. 8,9 The VBH technique has also been reported by Bartlett et al 9 to be superior to ABC in terms of patient acceptability and ease of implementation. However, areas of potential concern which might inhibit the rapid roll out of VBH into routine practice are (i) the stability of each breath hold, (ii) the magnitude of breath hold-to-breath-hold variation for a number of repeat breath holds, and (iii) the impact on delivered dose of a failure to maintain breath hold for the planned duration.…”

Cardiac Side-effects From Breast Cancer Radiotherapy

“…single-use mouthpieces) and equipment replacement. Taking these resource issues together with the Royal College of Radiologists' demonstration that heartsparing techniques were being used in only 4% of patients in 2012 (Imogen Locke, personal communication), the Marsden group developed a research programme exploring the use of a simple voluntary breath-hold technique that requires little more than a standard linear accelerator and a felt-tip pen [50]. The group showed that the voluntary breath-hold technique was as heart-sparing and reproducible as an Active Breathing CoordinatorÔ -based technique, treatment delivery was faster and it was more acceptable to patients and radiographers [51].…”

General Overview and Treatment Recommendations for Young Women with Breast Cancer

“…Different strategies to reduce the dose to thoracic organs are being researched [108][109][110] . Image-guided deep inspiratory breath hold is a reproducible and stable radiotherapy technique, which can be implemented as a voluntary, non-computer-controlled technique in breast/chest wall and/or locoregional radiotherapy, including its use in low-resource settings 111 . Deep inspiratory breath hold has been shown to significantly reduce dose to heart, left anterior descending coronary artery, and lung 108,112 .…”