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Should breathing adapted radiotherapy also be applied for right-sided breast irradiation?

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October 27. 2017
Rebekah Knight

Hi all,

Thank you to Mitch for suggesting a first article, which is particularly relevant in the department at the moment thinking about the run of right sided DIBH rapid arc patients we have coming on to TrueBeam.

Could I suggest that everyone reads the article by the end of next week (3rd Nov) and we can this use this space to discuss any thoughts or questions we might have?

The article is saved in the Documents space of the network.



November 07. 2017
Rebekah Knight

So to start things off- has everyone had chance to read the article?

November 09. 2017
Steffan Armstrong

Yes. Interesting read. Nice to read around a technique similar to one we do here at Derby. However, only one paragraph was actually dedicated to VMAT DIBH. I have to admit I had to read through some of the paper several times to get my head round some of the figures.

What I would say though is that the paper was published in 2015. In my opinion, a lot can happen in 2-3 years. Especially in radiotherapy. Techniques evolve for example. Also the sample of patients they used was fairly small and the age range quite restricted (with only 3 patients < 50 years of age).

Also, what the paper touched on very briefly - the technique and results are dependent on patient anatomy. 

November 14. 2017
Michelle Bradley

Good points Steffan.

I think it is also quite tricky to read through.

It does point out the differences in dose bath for these patients where a reduction in dose on one lung increases the dose in the ipsilateral  lung/breast.

The risk/benefit does have to be addressed as we wouldn't want to treat all our breast patients rapid arc - only the higher risk ones.

I think there is a place for some Right sided conformally treated patients to be treated in breathe hold but would be dependent on patient anatomy. Hopefully there will be more papers published in the UK as we develop these techniques.


November 20. 2017
Rebekah Knight

I also found it difficult to read! I had noticed the small sample size, (a grand total of 14!) but didn't pick up on how old the article was.

One of the things that we've discussed here that wasn't mentioned in the article was about breath hold improving stability in patient position? Did we ever compare/audit imaging values between left sided DIBH and right sided free breathing?

I agree with Mitch that there is definitely some place for DIBH in right sided patients but potentially not all.

If I get some time I'll have a dig on the SHU library site and see if I can find anymore recent articles for a bit of further reading if people are interested.

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