A Prospective Trial Demonstrating the Benefit of Personalized Selection Of Breath-Hold Technique for Upper-Abdominal Radiation Therapy Using the Active Breathing Coordinator
Autor: | Briana Farrugia, Mark Tacey, Caroline Wright, Richard Khor, Michael Chao, Kellie Knight, Farshad Foroudi |
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Rok vydání: | 2021 |
Předmět: |
Adult
Subset Analysis Cancer Research medicine.medical_treatment Disease course Breath Holding Humans Medicine Fluoroscopy Radiology Nuclear Medicine and imaging Prospective Studies Expiration Aged Aged 80 and over Screening assessment Radiation Active Breathing Coordinator medicine.diagnostic_test business.industry Radiotherapy Planning Computer-Assisted Reproducibility of Results Middle Aged Radiation therapy Oncology Prospective trial Dose Fractionation Radiation Nuclear medicine business |
Zdroj: | International Journal of Radiation Oncology*Biology*Physics. 111:1289-1297 |
ISSN: | 0360-3016 |
Popis: | Purpose For upper abdominal tumors, our institutional-standard motion reduction method is the expiration breath-hold (EBH) technique, using Active Breathing Coordinator (ABC). However, an individual patient's breath-hold (BH) reproducibility (RBH) may be improved in deep inspiration or inspiration breath-hold (DIBH or IBH). This trial compared the tumor position RBH, stability (SBH), and breath-hold time (TBH) of 3 BH methods, using ABC, to personalize the selection of technique, by using a preplanning screening assessment. Methods and Materials We invited patients planned for upper abdominal radiation therapy (kidney, pancreas, liver, or adrenal gland) to participate in this prospective trial. We conducted ABC education with the study participants, who then attempted EBH, DIBH, and IBH in randomized order. During 5 consecutive BH's for each method, we acquire kV fluoroscopy images of the diaphragm. We personalized the BH technique selection according to a decision matrix. We analyzed the EBH and the personalized technique cohort mean RBH and SBH. Results Between May 2019 and March 2020, we recruited 19 participants. Median age of participants was 68 years (range 32-81). Tumor sites included kidney (n = 1), adrenal gland (n = 5) and liver (n = 14). We excluded 1 participant due to poor BH compliance, leaving 270 images from 18 participants for analysis. Mean TBH was 22.1, 23.9, and 24.2 seconds for EBH, DIBH, and IBH respectively. Screening selected EBH for 44% (n = 8), IBH for 39% (n = 7), and DIBH for 17% (n = 3) of participants. The mean RBH was superior at 0.92 mm (0.79 mm SD) for the personalized technique, compared with EBH of 1.79 mm (1.49 mm SD) (P = .016). Preplanned subset analysis of participants whose personalized technique was not EBH showed improved mean RBH of 0.63 mm (0.29 mm SD) compared with their EBH RBH of 2.2 mm (1.7 mm SD) (P = .011). Conclusions In 56% of participants, DIBH or IBH demonstrated superior RBH compared with EBH. Personalised BH screening can inform selection of an ABC BH method which provides optimal RBH with improved TBH for an individual's planning and treatment course. |
Databáze: | OpenAIRE |
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