<abstract xmlns="http://www.w3.org/1999/xhtml">

<sec><h3>Background</h3>
<p>Cardioprotection is valued in radiotherapy for patients with left-sided breast cancer. Deep inspiration breath-hold (DIBH) technique can achieve cardioprotection well. However, during DIBH, the extent to which the heart enters the radiation field is affected by the movement of the thorax and diaphragm. The aim of this study was to analyze the correlation between the maximum distance of the heart entering the field (maximum heart distance, MHD) and thoracic diameter changes and diaphragmatic descent in left-sided breast cancer patients during DIBH.</p>
</sec>
<sec><h3>Patients and methods</h3>
<p>Ninety-eight patients with left-sided breast cancer were included in this retrospective study. They performed simulation in Sentinel-guided DIBH, and two sets of CT images were collected under both free breathing (FB) and DIBH, and diaphragm positions, anteroposterior thoracic diameter (ATD), transverse thoracic diameter (TTD), gating window level (GWL), and MHD were measured, and the change (Δ) of each parameter in DIBH relative to that in FB were calculated. Pearson or Spearman test were used to analyze the correlation between ΔMHD and the changes in other parameters.</p>
</sec>
<sec><h3>Results</h3>
<p>For all patients with DIBH, the average of ΔMHD was −8.3 mm, and the average of ΔATD and ΔTTD were 11.0 and 8.6 mm, and the median of both left diaphragmatic descent (LDD) and right diaphragmatic descent (RDD) were 35.0 mm, and the median of GWL was 11.1 mm. The correlation coefficients between MHD decrease (ΔMHD) and LDD, RDD, and ΔTTD were −0.430 (p = 0.000), −0.592 (p = 0.000) and 0.208 (p = 0.040), respectively, but not significantly correlated with ΔATD or GWL.</p>
</sec>
<sec><h3>Conclusions</h3>
<p>The MHD decrease showed a moderate correlation with diaphragmatic descent In Sentinel-guided DIBH for patients with left-sided breast cancer, while there was a weak or no correlation with thoracic diameter changes or GWL. Abdominal breathing can lower diaphragm more and may be more beneficial to the heart stay away from tangential field.</p>
</sec>
</abstract>

Background
Cardioprotection is valued in radiotherapy for patients with left-sided breast cancer. Deep inspiration breath-hold (DIBH) technique can achieve cardioprotection well. However, during DIBH, the extent to which the heart enters the radiation field is affected by the movement of the thorax and diaphragm. The aim of this study was to analyze the correlation between the maximum distance of the heart entering the field (maximum heart distance, MHD) and thoracic diameter changes and diaphragmatic descent in left-sided breast cancer patients during DIBH.

Patients and methods
Ninety-eight patients with left-sided breast cancer were included in this retrospective study. They performed simulation in Sentinel-guided DIBH, and two sets of CT images were collected under both free breathing (FB) and DIBH, and diaphragm positions, anteroposterior thoracic diameter (ATD), transverse thoracic diameter (TTD), gating window level (GWL), and MHD were measured, and the change (Δ) of each parameter in DIBH relative to that in FB were calculated. Pearson or Spearman test were used to analyze the correlation between ΔMHD and the changes in other parameters.

Results
For all patients with DIBH, the average of ΔMHD was −8.3 mm, and the average of ΔATD and ΔTTD were 11.0 and 8.6 mm, and the median of both left diaphragmatic descent (LDD) and right diaphragmatic descent (RDD) were 35.0 mm, and the median of GWL was 11.1 mm. The correlation coefficients between MHD decrease (ΔMHD) and LDD, RDD, and ΔTTD were −0.430 (p = 0.000), −0.592 (p = 0.000) and 0.208 (p = 0.040), respectively, but not significantly correlated with ΔATD or GWL.

Conclusions
The MHD decrease showed a moderate correlation with diaphragmatic descent In Sentinel-guided DIBH for patients with left-sided breast cancer, while there was a weak or no correlation with thoracic diameter changes or GWL. Abdominal breathing can lower diaphragm more and may be more beneficial to the heart stay away from tangential field.

Correlation between maximum heart distance and thoracic diameter changes and diaphragmatic descent in left-sided breast cancer patients during deep inspiration breath-hold (DIBH)

Department of Radiation Oncology, Shenzhen People's Hospital

The Second Clinical Medical College of Jinan University

Radiology and Oncology

This work is licensed under the Creative Commons Attribution 4.0 International License.

Background
Cardioprotection is valued in radiotherapy for patients with left-sided breast cancer. Deep inspiration breath-hold (DIBH) technique can achieve...

Correlation between maximum heart distance and thoracic diameter changes and diaphragmatic descent in left-sided breast cancer patients during deep inspiration breath-hold (DIBH)

Article Category: Research Article

Published Online: Nov 30, 2023

Page range: 530 - 537

Received: Apr 13, 2023

Accepted: Aug 28, 2023

DOI: https://doi.org/10.2478/raon-2023-0053

Keywords
left-sided breast cancer, maximum heart distance, thoracic diameter, diaphragmatic descent, deep inspiration breath-hold

© 2023 He-Gou Wu et al., published by Sciendo

This work is licensed under the Creative Commons Attribution 4.0 International License.

Correlation between maximum heart distance and thoracic diameter changes and diaphragmatic descent in left-sided breast cancer patients during deep inspiration breath-hold (DIBH)

Article Category: Research Article

Published Online: Nov 30, 2023

Page range: 530 - 537

Received: Apr 13, 2023

Accepted: Aug 28, 2023

DOI: https://doi.org/10.2478/raon-2023-0053

Keywordsleft-sided breast cancer, maximum heart distance, thoracic diameter, diaphragmatic descent, deep inspiration breath-hold

© 2023 He-Gou Wu et al., published by Sciendo

This work is licensed under the Creative Commons Attribution 4.0 International License.

Keywords
left-sided breast cancer, maximum heart distance, thoracic diameter, diaphragmatic descent, deep inspiration breath-hold