Feasibility of increasing heart to chest wall distance and relationship between respiratory amplitude and heart to chest wall distance in left breast cancer radiotherapy using abdominal compression
Keywords:
Moderate deep inspiration breath hold, Heart to chest wall distance, Respiratory amplitude, Abdominal CompressionAbstract
Backgrounds: In radiotherapy for left sided breast cancer, the radiation dose to the heart and left anterior descending artery (LAD) are major concerns. There have been attempts to develop an effective and reproducible radiotherapy technique in order to minimize dose to the organ at risk.
Objectives: To investigate the use of the Abdominal Compression (AC) with moderate deep inspiration breath hold technique (mDIBH+AC) in left side breast cancer radiotherapy. The primary objective was to evaluate an increasing of the heart to chest wall distance by using mDIBH+AC along with the relationship between respiratory amplitude and the heart to chest wall distance. The secondary objective was to assess the radiation doses delivered to the heart and LAD and duration for breath hold technique.
Materials and methods: Eleven patients with left sided breast cancer were enrolled in our study. CT simulation was undergone and recorded respiratory signal with Anzai Belt system in 3 data sets: Free breath (FB), Deep inspiration breath hold (DIBH) and moderate deep inspiration breath hold with abdominal compression (mDIBH+AC). Respiratory signal was analyzed with Fourier Transform technique. Then, the heart to chest wall distance, the respiratory amplitude and radiation doses of the heart and LAD from the radiation treatment plans were evaluated. The time of breath hold was also compared between DIBH and mDIBH+AC.
Results: The average heart to chest wall distances were 0.46 ± 0.22, 0.99 ± 0.57 and 0.97± 0.54 cm for FB, DIBH and mDIBH+AC, respectively. We found a moderate positive correlation between respiratory amplitude and the heart to chest wall distance with a statistically significant Pearson correlation coefficient of 0.623. Using mDIBH+AC reduced Dmean, Dmax,V20Gy and V30Gy of the heart by 5.40%, 5.39%, 23.02% and 28.14%, respectively, and Dmean, Dmax and D2% on LAD by 13.77%, 6.59% and 7.16%, respectively when compared with FB. Moreover, the duration of breath hold in mDIBH+AC was longer than DIBH in most patients, increased from 28.52±6.54 sec to 31.13±8.35 sec (p=0.122).
Conclusions: Using of AC is effective to increase the heart to chest wall distance including reducing radiation dose to the heart and LAD compared with FB. Moreover, AC showed improving stability of mDIBH.
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