Reduced lung dose and improved inspiration level reproducibility in visually guided DIBH compared to audio coached EIG radiotherapy for breast cancer patients
| Autor: | J.P. Bangsgaard, Anders N. Pedersen, Ivan R. Vogelius, Mirjana Josipovic, Sidsel Marie Skov Damkjær, Marianne C. Aznar |
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| Rok vydání: | 2013 |
| Předmět: |
Adult
Organs at Risk medicine.medical_specialty medicine.medical_treatment Breast Neoplasms Computed tomography Respiratory signal Breast cancer medicine Humans Radiology Nuclear Medicine and imaging Radiation Injuries Radiometry Lung Aged Neoplasm Staging Deep inspiration breath-hold Aged 80 and over Reproducibility medicine.diagnostic_test business.industry Radiotherapy Planning Computer-Assisted Respiration Visually guided Reproducibility of Results Hematology General Medicine Middle Aged Prognosis medicine.disease Radiation therapy medicine.anatomical_structure Inhalation Oncology Female Radiology Tomography X-Ray Computed business Radiotherapy Image-Guided |
| Zdroj: | Acta Oncologica. 52:1458-1463 |
| ISSN: | 1651-226X 0284-186X |
| DOI: | 10.3109/0284186x.2013.813073 |
| Popis: | Patients with left-sided breast cancer with lymph node involvement have routinely been treated with enhanced inspiration gating (EIG) for a decade at our institution. In a transition from EIG to deep inspiration breath hold (DIBH) we compared the two techniques with focus on target coverage, dose to organs at risk and reproducibility of the inspiration level (IL).Twenty-four patients were computed tomography (CT) scanned with EIG and DIBH. For DIBH we used visual feedback and for EIG audio coaching, both during scan and treatment. Treatment plans for 50 Gy over 25 fractions were calculated. Seventeen of the patients were included in the analysis of reproducibility. They were audio coached for one minute before beam-on in DIBH at nine treatment sessions. These respiration curves were analysed with average maximum IL and standard deviation (SD) for the EIG part of the respiratory signal, and mean IL and SD for the DIBH. Comparison of dosimetric and respiration parameters were performed with the Wilcoxon signed rank-sum test.In DIBH, the ipsilateral lung volume increased further compared to EIG (p0.0004, mean increase 11%). This lead to a 9% mean reduction (p = 0.002) of the ipsilateral lung volume receiving 20 Gy (V20 Gy). We found no other significant dosimetric differences between the two methods. The reproducibility of the IL was better with the DIBH method, observed as a significantly smaller SD in most patients (p0.04 for 16 of 17 patients).The DIBH method resulted in a significantly larger lung volume and lower ipsilateral lung V20 Gy compared to EIG. The IL for visually guided DIBH was more reproducible than audio-coached EIG. Based on these findings, the DIBH technique is our new breathing adaptation standard for radiotherapy of patients with left-sided breast cancer with lymph node involvement. |
| Databáze: | OpenAIRE |
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