Utility of Deep Inspiration Breath Hold for Left-Sided Breast Radiation Therapy in Preventing Early Cardiac Perfusion Defects: A Prospective Study

Timothy M. Zagar, Orit Kaidar-Person, Xiaoli Tang, Ellen E. Jones, Jason Matney, Shiva K. Das, Rebecca L. Green, Arif Sheikh, Amir H. Khandani, William H. McCartney, Jorge Daniel Oldan, Terence Z. Wong, Lawrence B. Marks

International Journal of Radiation Oncology*Biology*Physics, Volume 97, Issue 5, April 2017, Pages 903 - 909


To 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).

Methods and Materials

We 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). The DIBH was done by use of a controlled surface monitoring technique (AlignRT, Vision RT Ltd, London, UK). The RT was given with tangential fields and a heart block. Radiation-induced cardiac perfusion and wall motion changes were assessed by pre-RT and 6-month post-RT SPECT scans. A cumulative SPECT summed-rest score was used to quantify perfusion in predefined left ventricle segments. The incidence of wall motion abnormalities was assessed in each of these same segments.


A total of 20 patients with normal pre-RT scans were studied; their median age was 56 years (range, 39-72 years). Seven (35%) patients also received irradiation to the left internal mammary chain, and 5 (25%) received an additional RT field to supraclavicular nodes. The median heart dose was 94 cGy (range, 56-200 cGy), and the median V25Gywas zero (range, 0-0.1). None of the patients had post-RT perfusion or wall motion abnormalities.


Our 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.


03/22/2017 - 09:15