| Sun Xiangshang,Zhou Borong,Huang Shixiong,et al.Robustness analysis of deep inspiration breath-hold technique against dosimetric variations induced by positioning errors for postoperative left-sided breast cancer[J].Chinese Journal of Radiological Medicine and Protection,2026,46(3):264-272 |
| Robustness analysis of deep inspiration breath-hold technique against dosimetric variations induced by positioning errors for postoperative left-sided breast cancer |
| Received:May 27, 2025 |
| DOI：10.3760/cma.j.cn112271-20250527-00179 |
| KeyWords:Breast cancer Postoperative adjuvant radiotherapy Positioning error Deep inspiration breath-hold |
| FundProject:湖南省自然科学基金面上项目(2023JJ30373);湖南省肿瘤医院科研攀登计划启航青年基金(QH2023010) |
| Author Name | Affiliation | E-mail | | Sun Xiangshang | Department of Radiation Oncology, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Hunan Cancer Hospital, Changsha 410013, China | | | Zhou Borong | Department of Radiation Oncology, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Hunan Cancer Hospital, Changsha 410013, China | | | Huang Shixiong | Department of Radiation Oncology, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Hunan Cancer Hospital, Changsha 410013, China | | | Wang Zhiyan | Department of Radiation Oncology, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Hunan Cancer Hospital, Changsha 410013, China | | | Luo Lingrong | Department of Chest Radiation Oncology, Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Hunan Cancer Hospital, Changsha 410013, China | | | Zhang Li | Department of Radiation Oncology, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Hunan Cancer Hospital, Changsha 410013, China | | | Chen Luqiao | Department of Oncology, First Hospital of Changsha, Affiliated Changsha Hospital of Xiangya School of Medicine, Central South University, Changsha 410005, China | | | Ni Qianxi | Department of Radiation Oncology, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Hunan Cancer Hospital, Changsha 410013, China | niqianxi2014@163.com |
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| Abstract:: |
| Objective To investigate the robustness of deep inspiration breath-hold (DIBH) technique against dosimetric variations caused by positioning errors during intensity-modulated radiotherapy for postoperative left-sided breast cancer, and to provide a reference for clinical treatment. Methods A retrospective study was conducted using simple random sampling to select 34 patients who underwent postoperative radiotherapy for left-sided breast cancer at Hunan Cancer Hospital between September 2023 and September 2024. Among them, 17 patients were treated with the DIBH technique and 17 with free breathing (FB). All patients received volumetric modulated arc therapy(VMAT). Positioning errors during actual treatment were simulated by shifting the isocenter of the clinical plan by 5 mm along individual coordinate axes. The effects of positioning errors on dosimetric parameters for the clinical target volume (CTV) and organs at risk were analyzed with different breathing techniques. Results With the approved clinical plan, the DIBH group showed a higher percentage of the CTV receiving ≥49 Gy (t = 2.56, P<0.05), significantly lower percentages of left lung receiving ≥5 and ≥20 Gy, and significantly lower mean doses to the heart and left anterior descending coronary artery (LAD) and percentages of the heart and LAD receiving ≥20, ≥30, and ≥40 Gy (t = -5.33 to -2.09, P<0.05), as compared with the FB group. No statistically significant differences were found in the percentage of the right lung receiving ≥5 Gy or the mean dose to the right breast between the two groups. Under 5 mm unidirectional positioning errors, the percentages of the CTV receiving ≥49 Gy decreased in the DIBH and FB groups by 0.79%-2.67% and 0.82%-3.50%, respectively, though the percentages still met clinical requirements. In the FB group, the variations in the assessed dose-volume parameters for the heart, LAD, and left lung ranged from -2.55% to 3.51%, -21.54% to 23.23%, and -4.58% to 4.18%, respectively. Comparatively, the DIBH group demonstrated narrower variation ranges of -1.14% to 1.98% for the heart, -13.68% to 15.45% for the LAD, and -4.08% to 3.37% for the left lung. Conclusions Compared with FB, the DIBH technique offers dosimetric advantages in target coverage and sparing of organs at risk such as the heart and left lung during postoperative radiotherapy for left-sided breast cancer. It also demonstrates superior robustness in scenarios involving positioning errors. |
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