Preventing Cardiotoxicity in Personalized Breast Irradiation

background: this study aims to assess the benefit of a deep inspiration breath hold (DIBH) over the standard irradiation technique, and eventually to identify anatomical and/or treatment preplanning characteristics correlated with the LAD dose. methods: patients with left-sided breast cancer undergoing whole breast radiotherapy with DIBH were analyzed. all patients included in the analysis had plans in DIBH and free-breathing (FB). receiving operating characteristics (ROC analysis) were used to identify the cut-off point of parameters to predict the LAD maximum dose > 10 Gy and LAD mean dose > 4 gy, and the areas under the curve (AUCs) were computed. post-test probability has been performed to evaluate the effect of parameters' combination. results: one hundred ninety-seven patients were analyzed. the LAD dose was significantly reduced in DIBH plans with the maximum and mean dose reduced by 31.7% (mean value 3.5 Gy vs. 4.8 Gy, p <= 0.001) and 28.1% (mean value 8.2 Gy vs. 12.8 Gy, p <= 0.001) in DIBH plans compared to FB plans. the strongest predictor of the LAD dose (maximum > 10 Gy and mean > 4 Gy) was the minimum distance of LAD from tangent open fields. other parameters were lung volume and heart volume (LAD Dmax > 10 Gy) and lung volume, heart volume, and breast separation (LAD Dmean > 4 Gy). conclusion: the dosimetric advantage of DIBH is clear in all patients and DIBH should always be preferred.