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Intensity-modulated radiotherapy versus three-dimensional conformal radiotherapy during deep inspiratory breath hold for left-sided whole-breast irradiation: a comparative analysis

Published online by Cambridge University Press:  07 September 2015

D. M. Trifiletti ,
K. Wijesooriya ,
G. Moyer ,
D. Lain ,
C. Geesey ,
K. Forbes  and
K. A. Reardon
D. M. Trifiletti*
Affiliation:
Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
K. Wijesooriya
Affiliation:
Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
G. Moyer
Affiliation:
Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
D. Lain
Affiliation:
Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
C. Geesey
Affiliation:
Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
K. Forbes
Affiliation:
Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
K. A. Reardon
Affiliation:
Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
*
Correspondence to: Daniel M. Trifiletti, Department of Radiation Oncology, University of Virginia School of Medicine, PO Box 800383, Charlottesville, VA 22908, USA. Tel: 434 924 5191. E-mail: Daniel.trifiletti@gmail.com
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Abstract

Aim

Deep inspiratory breath hold (DIBH) during left-breast irradiation helps to minimise cardiac irradiation by physically separating the heart from the left breast. The dose to organs-at-risk in intensity-modulated radiotherapy (IMRT) and opposed tangent three-dimensional conformal radiotherapy (3DCRT) during DIBH in patients with left-sided breast cancer was compared.

Materials and methods

A total of 20 consecutive patients with left-sided breast cancer had a computed tomography scan utilising DIBH. Mean volumes of the heart, left anterior descending coronary artery, total lung and right breast receiving 5–95% of the prescription dose were calculated.

Results

Target volume homogeneity was improved with IMRT and average mean dose to target was higher for 3DCRT (51·03 Gy) compared with IMRT (50·47 Gy, p<0·01). The average mean dose to the heart was lower with 3DCRT (87 versus 77 cGy, p<0·01). The average mean dose to the contralateral breast was also lower with 3DCRT (19 versus 17 cGy, p<0·01). Less monitor units (MUs) were required with 3DCRT with an average difference of 225 MU/fraction (p<0·01).

Findings

Under DIBH, absolute differences between 3DCRT and IMRT were minimal. 3DCRT under DIBH provided excellent dosimetric results in most patients with left-sided breast cancer without the need for IMRT.

Keywords

breastdeep inspiratory breath holdheartintensity-modulated radiotherapyradiation
Type
Technical Note
Information
Journal of Radiotherapy in Practice , Volume 15 , Issue 1 , March 2016 , pp. 99 - 106
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Copyright
© Cambridge University Press 2015 

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