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Intensity-modulated radiotherapy versus three-dimensional conformal radiotherapy during deep inspiratory breath hold for left-sided whole-breast irradiation: a comparative analysis

  • D. M. Trifiletti (a1), K. Wijesooriya (a1), G. Moyer (a1), D. Lain (a1), C. Geesey (a1), K. Forbes (a1) and K. A. Reardon (a1)...



Deep inspiratory breath hold (DIBH) during left-breast irradiation helps to minimise cardiac irradiation by physically separating the heart from the left breast. The dose to organs-at-risk in intensity-modulated radiotherapy (IMRT) and opposed tangent three-dimensional conformal radiotherapy (3DCRT) during DIBH in patients with left-sided breast cancer was compared.

Materials and methods

A total of 20 consecutive patients with left-sided breast cancer had a computed tomography scan utilising DIBH. Mean volumes of the heart, left anterior descending coronary artery, total lung and right breast receiving 5–95% of the prescription dose were calculated.


Target volume homogeneity was improved with IMRT and average mean dose to target was higher for 3DCRT (51·03 Gy) compared with IMRT (50·47 Gy, p<0·01). The average mean dose to the heart was lower with 3DCRT (87 versus 77 cGy, p<0·01). The average mean dose to the contralateral breast was also lower with 3DCRT (19 versus 17 cGy, p<0·01). Less monitor units (MUs) were required with 3DCRT with an average difference of 225 MU/fraction (p<0·01).


Under DIBH, absolute differences between 3DCRT and IMRT were minimal. 3DCRT under DIBH provided excellent dosimetric results in most patients with left-sided breast cancer without the need for IMRT.


Corresponding author

Correspondence to: Daniel M. Trifiletti, Department of Radiation Oncology, University of Virginia School of Medicine, PO Box 800383, Charlottesville, VA 22908, USA. Tel: 434 924 5191. E-mail:


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