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Background: The deep inspiration breath hold technique (DIBH) is widely usedfor left-sided breast radiotherapy (RT), in order to reduce the dose to theheart and the risk of cardiotoxicity. The volumetric arc therapy (VMAT)technique increases the dose conformity to the planning target volume (PTV). Wehereby describe the procedure of combining VMAT and DIBH without a dedicatedequipment, and report a dosimetric study related on our implemented technique.Methods: The DIBH technique is based on voluntary breath hold of the patientwhich is controlled by a laser on tattoo marks. Patients were selecteddepending their ability to breath hold for 25s, and VMAT plans were optimizedwith an arrangement of 4 arcs with a maximum delivery time of 20s each. Aretrospective dosimetric study was undertaken on 30 patients treated with thistechnique: 10 received local (whole breast) RT (L-RT) with a simultaneousintegrated boost (SIB), 10 a locoregional (LR)RT of the chestwall, 10 a LR RTof the whole breast with SIB. For these patients, their DIBH-VMAT treatmentplans were compared to free breathing (FB) VMAT plans, and dose characteristicsof PTV and organs at risk (OAR) were evaluated. Results: The PTV coverage wasidentical among plans under DIBH or FB. The mean heart dose was reduced from2.8+/-0.9Gy in FB to 1.8+/-0.6Gy in DIBH for local RT, and reduced from3.4+/-1.3Gy in FB to 2.2+/-0.5Gy in DIBH for LR-RT. The ipsilateral mean lungdose was reduced by a factor of 12% for LR-RT, but remained unchanged for L-RTwith DIBH-VMAT compared to FB treatment. No significant differences wereobserved in the mean dose of contra-lateral organs with either DIBH or FB VMATtechniques. Conclusion: The VMAT-DIBH technique performed without a dedicatedbreath hold equipment, provided important dose reductions at the heart, whilepreserving the ipsilateral lung and contralateral normal tissues.

A volumetric Modulated Arc Therapy (VMAT) combined with deep inspiration  breath hold (DIBH) technique for adjuvant irradiation for left sided breast  cancer