Comparison of Heart Sparing Capability of Continuous Positive Airway Pressure and Deep-Inspirational Breath-Hold in Left-Sided Breast Cancer Radiation Therapy
C Choi1*, J Chang2, J Lee1, R Park1, Y Cho2, J Kim2, J Kim1, (1) Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, KR, (2) Department of Radiation Oncology, Gangnam Severance Hospital, Seoul, KR
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PO-GePV-T-105 (Sunday, 7/10/2022) [Eastern Time (GMT-4)]
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Purpose: Reducing the heart dose without losing the therapeutic benefits is crucial in breast cancer radiation therapy (RT) as it is associated with heart diseases. Continuous positive airway pressure (CPAP) is a novel breath-holding technique used in RT to achieve minimal heart dose and has a high tolerability and reasonable inter- and intrafractional reproducibility as proven in a recent study. The goal of this study was to determine and compare the degree of heart sparing in various breath-holding procedures used in left-sided breast cancer radiation therapy.
Methods: Thirty-six patients with left-sided breast cancer underwent planning CT (pCT) scans for RT using three different breath-holding techniques – CPAP, deep inspiration breath-hold (DIBH), and free-breathing (FB). Clinical target volume (CTV) and heart contours were automatically contoured on each pCT using an in-house deep learning-based auto contouring tool. The distance between the heart and the CTV (target-to-heart distance) was measured by calculating the three-dimensional centroid-to-centroid distance of the contours. Statistical significance was calculated using a two-tailed T-test with alpha of 0.05.
Results: The greatest average target-to-heart distance was found in DIBH pCT, followed by CPAP and FB which were 97.3, 94.3, and 87.8 mm, respectively. The difference between CPAP and DIBH, however, was not statistically significant (p>0.05). Both CPAP and DIBH had significantly greater heart-to-CTV distances than FB pCT.
Conclusion: We demonstrated that CPAP can separate the heart from the CTV to a comparable extent as the current standard-of-care DIBH, allowing patients to hold their breath more comfortably while still sparing the heart.
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