ABSTRACT Introduction: This study evaluates the changes in the lung volume (LV) exposed radiation during the breath cycle and whether these volume differences have an effect on both lung and target doses in breast carcinoma patients. Material and Methods: Ten patients with left breast carcinoma underwent breast conservative surgery or mastectomy receiving radiotherapy (RT) (breast or chest wall and regional lymph nodes) were included. For this study, planning computerized tomography (CT) images were obtained during deep inspiration (DI) and end of expiration (EE), besides free breathing (FB) to simulate breath cycles. Three-dimensional conformal or intensity-modulated RT planning was done to obtain dose-volume information using CT series taken FB, DI and EE. The treatment plan was done with FB images and exported to the DI and EE scans and re-calculated. Volume changes and calculated dose differences according to breath cycles were compared. Results: There were significant differences in the whole LV, ipsilateral LV and contralateral LV between FB-DI and EE-DI while no significant difference was seen between FB and EE. V20 was lower during DI than FB and EE but the difference was not significant. There was no significant variation in whole breast dose although significant dose variations were observed in mean MI, supraclaviculary and level III axillary lymph node doses between breath cycles. Conclusion: Breath cycle had no significant effect on whole breast dose although significantly changed regional lymph node doses in patients with breast carcinoma receiving whole breast and regional lymph nodes radio-therapy. V20 dose was lower during DI than FB and EE, but the difference was not significant.
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E. Göksel, E. Tezcanli, M. Garipağaoğlu, Ö. Şenkesen, H. Küçücük, M. Şengoz, N. Beşe and I. Aslay, "Effect of Breathing on Exposed Lung Volumes and Doses in Patients with Breast Carcinoma Receiving Radiotherapy," International Journal of Medical Physics, Clinical Engineering and Radiation Oncology, Vol. 2 No. 3, 2013, pp. 92-97. doi: 10.4236/ijmpcero.2013.23013.
 M. S. Moran and B. G. Haffty, “Radiation Techniques and Toxicities for Locally Advanced Breast Cancer,” Seminars in Radiation Oncology, Vol. 19, No. 4, 2009, pp. 244-255. doi:10.1016/j.semradonc.2009.05.007
 T. Rancati, B. Wennberg, P. Lind and G. Galiardi, “Early Clinical and Radiological Pulmonary Complications Following Breast Cancer Radiation Therapy: NTCP Fit with Four Different Models,” Radiotherapy & Oncology, Vol. 82, No. 3, 2007, pp. 308-316.
 L. B. Marks, S. M. Bentzen, J. O. Deasy, F. M. Kong, J. D. Bradley, I. S. Vogelius, et al., “Radiation Dose-Volume Effects in the Lung,” International Journal of Radiation Oncology, Biology, Physics, Vol. 76, No. 3, 2010, pp. 70-76. doi:10.1016/j.ijrobp.2009.06.091
 L. B. Marks, D. Hollis, M. Munley, G. Bentel, M. Garipagaoglu, M. Fan, et al., “The Role of Lung Perfusion Imaging in Predicting the Direction of Radiation-Induced Changes in Pulmonary Function Tests,” Cancer. Vol. 88, No. 9, 2000, pp. 2135-2141.
 E. D. Yorke, A. Jackson, K. E. Rosenzweig, L. Braban, S. A. Leibel and C. C. Ling, “Correlation of Dosimetric Factors and Radiation Pneumonitis for Non-Small-Cell Lung Cancer Patients in a Recently Completed Dose Escalation Study,” International Journal of Radiation Oncology, Biology, Physics, Vol. 63, No. 3, 2005, pp. 672-682.
 J. D. Bradley, A. Hope, I. El Naqa, A. Apte, P. E. Lindsay, W. Bosch, et al., “A Nomogram to Predict Radiation Pneumonitis, Derived from a Combined Analysis of RTOG 9311 and Institutional Data,” International Journal of Radiation Oncology, Biology, Physics, Vol. 69, No. 4, 2007, pp. 985-992. doi:10.1016/j.ijrobp.2007.04.077
 M. L. Hernando, L. B. Marks, G. C. Bentel, M. N. Zhou, D. Hollis, S. K. Das, et al., “Radiation-Induced Pulmonary Toxicity: A Dose-Volume Histogram Analysis in 201 Patients with Lung Cancer,” International Journal of Radiation Oncology, Biology, Physics, Vol. 51, No. 3, 2001, pp. 650-659. doi:10.1016/S0360-3016(01)01685-6
 Y. Seppenwoolde, K. D. Jaeger, L. J. Boersma, S. A. Belderbos and J. V. Lebesque, “Regional Differences in Lung Radiosensitivity after Radiotherapy for Nonsmall-Cell Lung Cancer,” International Journal of Radiation Oncology, Biology, Physics, Vol. 60, No. 3, 2004, pp. 748-758. doi:10.1016/j.ijrobp.2004.04.037
 V. M. Remouchamps, F. A. Vicini, M. B. Sharpe, L. L. Kestin, A. A. Martinez and J. W. Wong, “Significant Reductions in Heart and Lung Doses Using Deep Inspiration Breath Hold with Active Breathing Control and Intensity-Modulated Radiation Therapy for Patients Treated with Loco Regional Breast Irradiation,” International Journal of Radiation Oncology, Biology, Physics, Vol. 55, No. 2, 2003, pp. 392-406.
 A. N. Pedersen, S. Korreman, H. Nystrom and L. Specth, “Breathing Adapted Radiotherapy of Breast Cancer: Reduction of Cardiac and Pulmonary Doses Using Voluntary Inspiration Breath-Hold,” Radiotherapy & Oncology, Vol. 72, No. 1, 2004, pp. 53-60.
 P. M. K. Leung, B. Seaman and P. Robinson, “Low-Density Inhomogeneity Corrections for 22-MeV X-Ray Therapy,” Radiology, Vol. 94, No. 2, 1970, p. 449.
 R. O. Kornelson and M. E. J. Young, “Changes in the Dose-Profile of a 10 MV X-Ray Beam within and beyond Low Density Material,” Medical Physics, Vol. 9, No. 1, 1982, p. 114. doi:10.1118/1.595059
 J. Vikstrom, M. H. B. Hjelstuen, I. Mjaaland and K. I. Dybvik, “Cardiac and Pulmonary Dose Reduction for Tangentially Irradiated Breast Cancer, Utilizing Deep Inspiration Beath-Hold with Audio-Visual Guidance, without Compromising Target Coverage,” Acta Oncologica, Vol. 50, No. 1, 2011, pp. 42-50.
 R. C. Frazier, F. A. Vicini, M. B. Sharpe, D. Yan, J. Fayad, K. L. Baglan, et al., “Impact of Breathing Motion on Breast Radiotherapy: A Dosimetric Analysis Using Active Breathing Control,” International Journal of Radiation Oncology, Biology, Physics, Vol. 58, No. 4, 2004, pp. 1041-1047. doi:10.1016/j.ijrobp.2003.07.005
 E. Tezcanli, E. Goksel, E. Yildiz, M. Garipagaoglu, O. Senkesen, H. Kucucuk, et al., “Does Radiotherapy Planning without Breath Control Compensate Intra-Fraction Heart and Its Compartments’ Movement?” Breast Cancer Research and Treatment, Vol. 126, No. 1, 2011, pp. 85-92. doi:10.1007/s10549-010-1306-0
 X. A. Li, A. Tai, D. W. Arthur, T. A. Buchholz, S. Mac-Donald, L. B. Marks, et al., “Variability of Target and Normal Structure Delineation for Breast-Cancer Radio-therapy: A RTOG Multi-Institutional and Multi-Observer Study,” International Journal of Radiation Oncology, Biology, Physics, Vol. 73, No. 3, 2009, pp. 944-951.
 T. I. Lingos, A. Recht, F. Vicini, A. Abner, B. Silver and J. R. Harris, “Radiation Pneumonitis in Breast Cancer Patients Treated with Conservative Surgery and Radiation Therapy,” International Journal of Radiation Oncology, Biology, Physics, Vol. 21, No. 2, 1991, pp. 355-360.
 A. G. Taghian, S. I. Assaad, A. Niemierko, I. Kuter, J. Younger, R. Schoenthaler, et al., “Risk of Pneumonitis in Breast Cancer Patients Treated with Radiation Therapy and Combination Chemotherapy with Paclitaxel,” Journal of the National Cancer Institute, Vol. 93, No. 23, 2001, pp. 1806-1811. doi:10.1093/jnci/93.23.1806
 H. Stranzl, B. Zurl, T. Langsenlehner, K. S. Kapp, “Wide-tangential Fields Including the Internal Mammary Lymph Nodes in Patients with Left-Sided Breast Cancer,” Strahlentherapie und Onkologie, Vol. 185, No. 2, 2009, pp. 155-160. doi:10.1007/s00066-009-1939-2
 E. J. Hall, C. S. Wuu, “Radiation-Induced Second Cancers: The Impact of 3D-CRT and IMRT,” International Journal of Radiation Oncology, Biology, Physics, Vol. 56, No. 1, 2003, pp. 83-88.
 G. Gagliardi, J. Bjohle, I. Lax, A. Ottolenghi, F. Eriksson, A. Liedberg, et al., “Radiation Pneumonitis after Breast Cancer Irradiation: Analysis of the Complication Probability Using the Relative Seriality Model,” International Journal of Radiation Oncology, Biology, Physics, Vol. 46, No. 2, 2000, pp. 373-381.
 N. Wolmark, W. J. Curran, F. Vicini, J. White, J. P. Costantino, D. Arthur, et al., “Toxicity of Three-Dimensional Conformal Radiotherapy for Accelerated Partial Breast Irradiation,” International Journal of Radiation Oncology, Biology, Physics, Vol. 75, No. 3, 2009, pp. 1290-1296.
 A. J. Hope, P. E. Lindsay, I. El Naqa, J. R. Alaly, M. Vicic, J. D. Breadley, et al., “Modeling Radiation Pneumonitis Risk with Clinical, Dosimetric, and Spatial Parameters,” International Journal of Radiation Oncology, Biology, Physics, Vol. 65, No. 1, 2006, pp. 112-124.