Background

Although deep inspiratory breath-hold (DIBH) is routinely used for left-sided breast cancers, its benefits for right-sided breast cancer (rBC) have yet to be established. We compared free-breathing (FB) and DIBH treatment plans for a cohort of rBC undergoing regional nodal irradiation (RNI) to determine its potential benefits.

Methods and Materials

rBC patients considered for RNI (internal mammary nodal chains, supraclavicular field, with or without axilla) from October 2017 to May 2020 were included in this analysis. For each patient, FB versus DIBH plans were generated and dose volume histograms evaluated the following parameters: mean lung dose, ipsilateral lung V₂₀/V₅ (volumes of lung receiving 20 Gy and 5 Gy, respectively); mean heart dose and heart V₅ (volumes of heart receiving 5 Gy); liver V_{20 absolute} /V_{30 absolute} (absolute volume of liver receiving 20 Gy and 30 Gy, respectively), liver D_max, and total liver volume irradiated (TVI_liver). The dosimetric parameters were compared using Wilcoxon signed-rank testing.

Results

Fifty-four patients were eligible for analysis, comparing 108 FB and DIBH plans. DIBH significantly decreased all lung and liver parameters: mean lung dose (19.7 Gy-16.2 Gy, P < .001), lung V₂₀ (40.7%-31.7%, P < .001), lung V₅ (61.2%-54.5%, P < .001), TVI_liver (1446 cc vs 1264 cc; P = .006) liver D_max (50.2 Gy vs 48.9 Gy; P = .023), liver V₂₀ (78.8-23.9 cc, P < .001), and liver V₃₀ (58.1-14.6 cc, P < .001) compared with FB. DIBH use did not significantly improve heart parameters, although the V_5Heart trended on significance (1.25-0.6, P = .067).

Conclusions

This is the largest cohort to date analyzing DIBH for RNI-rBC. Our findings demonstrate significant improvement in all lung and liver parameters with DIBH, supporting its routine consideration for rBC patients undergoing comprehensive RNI.

中文翻译：

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局部淋巴结照射时深吸气屏气对右侧乳腺癌的益处

背景

尽管深吸气屏气 (DIBH) 通常用于左侧乳腺癌，但其对右侧乳腺癌 (rBC) 的益处尚未确定。我们比较了一组接受区域淋巴结照射 (RNI) 的 rBC 的自由呼吸 (FB) 和 DIBH 治疗计划，以确定其潜在益处。

方法和材料

该分析包括 2017 年 10 月至 2020 年 5 月期间考虑接受 RNI（内乳淋巴结链、锁骨上野、有或无腋窝）的 rBC 患者。对于每位患者，生成 FB 与 DIBH 计划，剂量体积直方图评估以下参数：平均肺剂量，同侧肺 V ₂₀ /V ₅（分别接受 20 Gy 和 5 Gy 的肺体积）；平均心脏剂量和心脏 V ₅（接受 5 Gy 的心脏体积）；肝脏 V _{20 绝对值}/V _{30 绝对值}（分别接受 20 Gy 和 30 Gy 的肝脏绝对体积）、肝脏 D _max和照射的总肝脏体积（TVI_肝脏）。使用 Wilcoxon 符号秩检验比较剂量学参数。

结果

54 名患者符合分析条件，比较了 108 个 FB 和 DIBH 计划。DIBH 显着降低所有肺和肝脏参数：平均肺剂量 (19.7 Gy-16.2 Gy, P < .001), 肺 V ₂₀ (40.7%-31.7%, P < .001), 肺 V ₅ (61.2%-54.5% , P < .001), TVI_肝(1446 cc vs 1264 cc; P  = .006) 肝 D _max (50.2 Gy vs 48.9 Gy; P  = .023), 肝 V ₂₀ (78.8-23.9 cc, P < .001 )，肝脏 V ₃₀ (58.1-14.6 cc, P < .001) 与 FB 相比。DIBH 的使用并没有显着改善心脏参数，尽管 V_5心脏的显着性趋势（1.25-0.6，P  = .067）。

结论

这是迄今为止分析 RNI-rBC 的 DIBH 的最大队列。我们的研究结果表明，DIBH 的所有肺和肝脏参数都有显着改善，支持对接受综合 RNI 的 rBC 患者进行常规考虑。