CLINICAL RESULTS OF IMAGE-GUIDED DEEP INSPIRATION BREATH HOLD BREAST IRRADIATION

Purpose To evaluate the feasibility, cardiac dose reduction, and the Influence of the setup error on the delivered dose for fluoroscopy guided deep inspiration breath hold (DIBH) irradiation using a cone beam CT for irradiation of left sided breast cancer patients Methods and Materials Nineteen patients treated according to the DIBH protocol were evaluated regarding dose to the ipsilateral breast (or thoracic wall), heart, (left ventricle [LV] and left anterior descending artery [LAD]), and lung The DIBH treatment plan was compared to the free-breathing (FB) treatment planning and to the dose data in which setup error v, as taken into account (i e, actual delivered dose) Results The largest setup variability was observed in the direction perpendicular to the RT field (mu =-0 8 mm, Sigma= 2 9 mm, sigma=2 0 mm) The mean (D-mean) and maximum (D-max) doses of the DIBH treatment plan was significantly lower compared with the FB treatment plan for the heart (34% and 25%,p < 0 001), LV (71% and 28%,p < 0 001), and LAD (52% and 39 8%,p < 0 001) For some patients, large differences were observed between the heart D-max according to the DIBH treatment plan and the actual delivered dose (up to 71%), although D-max was always smaller than the planned FB dose (mean group reduction = 29%,p < 0 001) Conclusion The image guided DIBH treatment protocol is a feasible irradiation method with small setup variability that significantly reduces the dose to the heart, LV, and LAD (C) 2010 Elsevier Inc