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@ARTICLE{Wolf:181626,
      author       = {J. Wolf$^*$ and S. Stoller$^*$ and J. Lübke$^*$ and T.
                      Rothe$^*$ and M. Serpa$^*$ and J. Scholber$^*$ and C.
                      Zamboglou$^*$ and E. Gkika$^*$ and D. Baltas$^*$ and I.
                      Juhasz-Böss and V. Verma and D. Krug and A.-L. Grosu$^*$
                      and N. Nicolay$^*$ and T. Sprave$^*$},
      title        = {{D}eep inspiration breath-hold radiation therapy in
                      left-sided breast cancer patients: a single-institution
                      retrospective dosimetric analysis of organs at risk doses.},
      journal      = {Strahlentherapie und Onkologie},
      volume       = {199},
      number       = {4},
      issn         = {0179-7158},
      address      = {Heidelberg},
      publisher    = {Springer Medizin},
      reportid     = {DKFZ-2022-02120},
      pages        = {379-388},
      year         = {2023},
      note         = {2023 Apr;199(4):379-388},
      abstract     = {Radiotherapy can induce cardiac injury in left-sided breast
                      cancer cases. Cardiac-sparing irradiation using the deep
                      inspiration breath-hold (DIBH) technique can achieve
                      substantial dose reduction to vulnerable cardiac
                      substructures compared with free breathing (FB). This study
                      evaluated the dosimetric differences between both techniques
                      at a single institution.From 2017 to 2019, 130 patients with
                      left-sided breast cancer underwent breast-conserving surgery
                      (BCS; n = 121, $93.1\%)$ or mastectomy (ME; n = 9, $6.9\%)$
                      along with axillary lymph node staging (n = 105, $80.8\%),$
                      followed by adjuvant irradiation in DIBH technique; adjuvant
                      systemic therapy was included if applicable. 106 $(81.5\%)$
                      patients received conventional and 24 $(18.5\%)$
                      hypofractionated irradiation. Additionally, 12 patients
                      received regional nodal irradiation. Computed tomography
                      (CT) scans in FB and DIBH position were performed for all
                      patients. Intrafractional 3D position monitoring of the
                      patient surface in deep inspiration and breath gating was
                      performed using Sentinel and Catalyst HD 3D surface scanning
                      systems (C-RAD, Catalyst, C‑RAD AB, Uppsala, Sweden).
                      Individual coaching and determination of breathing amplitude
                      during the radiation planning CT was performed.
                      Three-dimensional treatment planning was performed using
                      standard tangential treatment portals (6 or 18 MV). The
                      delineation of cardiac structures and both lungs was done in
                      both the FB and the DIBH scan.All dosimetric parameters for
                      cardiac structures were significantly reduced (p < 0.01 for
                      all). The mean heart dose (Dmean) in the DIBH group was 1.3
                      Gy (range 0.5-3.6) vs. 2.2 Gy (range 0.9-8.8) in the FB
                      group (p < 0.001). The Dmean for the left ventricle (LV) in
                      DIBH was 1.5 Gy (range 0.6-4.5), as compared to 2.8 Gy
                      (1.1-9.5) with FB (p < 0.001). The parameters for LV (V10
                      Gy, V15 Gy, V20 Gy, V23 Gy, V25 Gy, V30 Gy) were reduced by
                      about $100\%$ (p < 0.001). The LAD Dmean in the DIBH group
                      was 4.1 Gy (range 1.2-33.3) and 14.3 Gy (range 2.4-37.5) in
                      the FB group (p < 0.001). The median values for LAD such as
                      V15 Gy, V20 Gy, V25 Gy, V30 Gy, and V40 Gy decreased by
                      roughly $100\%$ (p < 0.001). An increasing volume of left
                      lung in the DIBH position resulted in dose sparing of
                      cardiac structures.For all ascertained dosimetric
                      parameters, a significant dose reduction could be achieved
                      in DIBH technique.},
      keywords     = {Breast cancer (Other) / Cardiac-sparing (Other) / Deep
                      inspiration breath-hold radiation therapy (Other) / Heart
                      toxicity (Other) / Left-sided (Other)},
      cin          = {FR01 / E055},
      ddc          = {610},
      cid          = {I:(DE-He78)FR01-20160331 / I:(DE-He78)E055-20160331},
      pnm          = {315 - Bildgebung und Radioonkologie (POF4-315)},
      pid          = {G:(DE-HGF)POF4-315},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:36074138},
      doi          = {10.1007/s00066-022-01998-z},
      url          = {https://inrepo02.dkfz.de/record/181626},
}