ALCC offers Deep Inspiration Breath Hold
The Andrew Love Cancer Centre (ALCC) radiotherapy department now offers Deep Inspiration Breath Hold (DIBH) to all patients with left sided breast cancer. DIBH is one technique that can help reduce the volume of heart within the treatment area, thereby reducing the potential risk of long term side effects to the heart.
When treating a breast cancer patient with radiation, the aim is to treat the whole breast. This is achieved via tangential fields, which allow the whole breast to be treated while minimising the amount of lung in the treatment field. Patients are told to breathe freely during their treatment- which, when treating patients with a left sided breast cancer, can occasionally mean that a portion of heart is in the treatment field.
DIBH involves the patient taking a deep breath and holding it for about 20 seconds while the radiation is being delivered to the breast. The deep breath causes the lungs to expand which moves the heart away from the treatment field (figure 1).
Fig 1. Free-breathing vs. DIBH treatment plans.
A small screen is placed above the patient during treatment which provides visual feedback of their breathing cycle and target breath hold area (figure 2). Following instructions given by the radiation therapists operating the treatment machine, the patient inhales until they reach the target area, then holds their breath while the treatment is delivered. The machine automatically turns off if the patient does not hold within the targeted area, allaying the fear of “What if I need to breathe during the treatment?”
Long term side effects of radiotherapy can occur years after the completion of treatment and are becoming more of an issue as survival rates for breast cancer are increasing. Minimising potential side effects to the heart is vital for all patients, especially younger patients, and those with comorbidities such as history of heart disease, hypertension or high cholesterol.
The ALCC radiotherapy department treats approximately 300 breast cancer patients a year, and DIBH has been in use since December 2016.
Figure 2: DIBH equipment.
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