Utility of Deep inspiration breath-hold for left sided breast radiation therapy in preventing early cardiac perfusion defects - A Prospective Study

Publication date: Available online 18 December 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Timothy Zagar, Orit Kaidar - Person, Xiaoli Tang, Ellen Jones, Jason Matney, Shiva Das, Rebecca L. Green, Arif Sheikh, Amir H. Khandani, William H. McCartney, Jorge Daniel Oldan, Terence Z. Wong, Lawrence Bruce Marks
PurposeTo evaluate early cardiac single photon computed tomography (SPECT) findings after left breast/chest wall postoperative radiation therapy (RT) in the setting of deep inspiration breath hold (DIBH).MethodsWe performed a prospective single-institution- single arm study of patients who were planned for tangential RT with DIBH to the left breast/chest wall (+/- internal mammary nodes). Deep inspiration breath hold was done utilizing a controlled surface monitoring technique (AlignRT, Vision RT Ltd., London, UK). Radiation therapy was given with tangential fields and a heart block. Radiation-induced cardiac perfusion and wall-motion changes were assessed using pre-RT and 6 month post-RT SPECT scans. A cumulative SPECT summed-rest score (SRS) was used to quantify perfusion in predefined left ventricle segments. The incidence of wall-motion abnormalities was assessed in each of these same segments.ResultsA total of 20 patients with normal pre-RT scans were studied; median age 56 years (range, 39-72). Seven (35%) patients were also irradiated to left internal mammary chain, and 5 (25%) had an additional RT field to supraclavicular nodes. Median heart dose 94cGy (range, 56-200), median V25Gy was zero (range, 0-0.1). None of the patients had post-RT perfusion or wall motion abnormalities.ConclusionsOur results suggest that DIBH and conformal cardiac blocking for patients receiving tangential RT for left-sided breast cancer is an effective means to avoid early RT-associated cardiac perfusion defects.

Teaser

To evaluate radiation induced cardiac toxicity after left breast/chest wall adjuvant radiation in the setting of Vision RT-based deep inspiration breath hold. We performed a prospective single-institution- single arm study. Our results suggest that Vision RT-based deep inspiration breath hold for patients receiving adjuvant tangential radiation for left-sided breast cancer is an effective means to avoid radiation-associated cardiac perfusion and motion defects.


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