The effect of deep inspiration breath hold (DIBH) Intensity-Modulated Radiation Therapy (IMRT) on sparing healthy tissues in the treatment of lymphoma involving the mediastinum

Survivors of Hodgkin’s lymphoma have an increased risk of developing secondary malignancies and cardiovascular disease. This risk is directly correlated to the amount of radiation exposure and is significant even with the use of modern radiation therapy modalities. Deep inspiration breath hold (DIBH) techniques have been shown to lead to the delivery of lower amounts of radiation to organs at risk (OARs) during the treatment of breast cancer and Hodgkin’s lymphoma. In this study, we evaluated the ability to DIBH techniques to decrease the amount of radiation exposure of OAR in 16 consecutive patients presenting to our cancer center for treatment of early stage mediastinal lymphoma. We determined that the amount of radiation delivered to the heart was significantly lower with DIBH techniques compared to conventional free breathing. In addition, the coronary arteries and aortic valve received less than half of the radiation when DIBH was used. Smaller lung volumes were exposed to low dose radiation (V5) with breath holding compared to free breathing as well. These findings are consistent with previous reports and suggest that utilizing DIBH could greatly decrease the radiation exposure of OAR and decrease the long-term complications young cancer survivors face