The UK HeartSpare study: randomised evaluation of voluntary deep-inspiratory breath-hold in women undergoing breast radiotherapy

Abstract

Purpose: to determine whether voluntary deep-inspiratory breath-hold (v_DIBH) and deep-inspiratory breath-hold with the active breathing coordinator™ (ABC_DIBH) in patients undergoing left breast radiotherapy are comparable in terms of normal-tissue sparing, positional reproducibility and feasibility of delivery.

Methods: following surgery for early breast cancer, patients underwent planning-CT scans in v_DIBH and ABC_DIBH. Patients were randomised to receive one technique for fractions 1–7 and the second technique for fractions 8–15 (40?Gy/15 fractions total). Daily electronic portal imaging (EPI) was performed and matched to digitally-reconstructed radiographs. Cone-beam CT (CBCT) images were acquired for 6/15 fractions and matched to planning-CT data. Population systematic (?) and random errors (?) were estimated. Heart, left-anterior-descending coronary artery, and lung doses were calculated. Patient comfort, radiographer satisfaction and scanning/treatment times were recorded. Within-patient comparisons between the two techniques used the paired t-test or Wilcoxon signed-rank test.

Results: twenty-three patients were recruited. All completed treatment with both techniques. EPI-derived ? were ?1.8?mm (v_DIBH) and ?2.0?mm (ABC_DIBH) and ? ?2.5?mm (v_DIBH) and ?2.2?mm (ABC_DIBH) (all p non-significant). CBCT-derived ? were ?3.9?mm (v_DIBH) and ?4.9?mm (ABC_DIBH) and ? ??4.1?mm (v_DIBH) and ??3.8?mm (ABC_DIBH). There was no significant difference between techniques in terms of normal-tissue doses (all p non-significant). Patients and radiographers preferred v_DIBH (p?=?0.007, p?=?0.03, respectively). Scanning/treatment setup times were shorter for v_DIBH (p?=?0.02, p?=?0.04, respectively).

Conclusions: v_DIBH and ABC_DIBH are comparable in terms of positional reproducibility and normal tissue sparing. v_DIBH is preferred by patients and radiographers, takes less time to deliver, and is cheaper than ABC_DIBH

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