Cargando…
Voluntary versus ABC breath-hold in the context of VMAT for breast and locoregional lymph node radiotherapy including the internal mammary chain
BACKGROUND: Deep-inspiration breath-hold (DIBH) reduces radiation dose to the heart in patients undergoing locoregional breast radiotherapy. In the context of tangential irradiation of the breast/ chest wall, a voluntary breath hold (vDIBH) technique has been shown to be as reproducible as a machine...
Autores principales: | , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7918266/ https://www.ncbi.nlm.nih.gov/pubmed/33681483 http://dx.doi.org/10.1016/j.ctro.2021.02.003 |
_version_ | 1783657886845501440 |
---|---|
author | Ranger, Alison Dunlop, Alex Grimwood, Alex Durie, Emily Donovan, Ellen Havilland, Jo Harris, Emma McNair, Helen Kirby, Anna M. |
author_facet | Ranger, Alison Dunlop, Alex Grimwood, Alex Durie, Emily Donovan, Ellen Havilland, Jo Harris, Emma McNair, Helen Kirby, Anna M. |
author_sort | Ranger, Alison |
collection | PubMed |
description | BACKGROUND: Deep-inspiration breath-hold (DIBH) reduces radiation dose to the heart in patients undergoing locoregional breast radiotherapy. In the context of tangential irradiation of the breast/ chest wall, a voluntary breath hold (vDIBH) technique has been shown to be as reproducible as a machine-assisted breath hold technique using the active breathing co-ordinator (ABC™, Elekta, Crawley, UK, ABC_DIBH). This study compares set-up reproducibility for vDIBH versus ABC_DIBH in patients undergoing volumetric-modulated arc radiotherapy (VMAT) for breast cancer, both with and without wax bolus. METHOD: Patients with breast cancer requiring pan regional lymph node VMAT +/− wax bolus in breath-hold were CT scanned in vDIBH and ABC_DIBH. Patients were randomised to receive one technique for fractions 1–7 and the other for fractions 8–15. Daily cone beam computed tomography (CBCT) was performed and registered to planning-CT using bony anatomy. Within-patient comparisons of mean daily chest wall position were made using a paired t-test. Population, systematic (∑) and random errors (α) were estimated. Intrafraction reproducibility was assessed by comparing chest wall position and diaphragm movement between consecutive breath holds on CBCT. RESULTS: 16 patients were recruited. All completed treatment with both techniques (9 patients with wax bolus, 7 patients without). CBCT derived ∑ were 2.1–6.4 mm (ABC_DIBH) and 2.1–4.9 mm (vDIBH), α were 1.7–2.6 mm (ABC_DIBH) and 2.2–2.7 mm (vDIBH) and mean daily chest wall displacements (MD) were 0.0–1.5 mm (ABC_DIBH) and (-)0.1–1.6 vDIBH (all p non-significant). Chest wall and diaphragm position was equivalent between consecutive breath holds in ABC and vDIBH (median difference 1.0 mm and 0.8 mm respectively, non p significant) demonstrating equivalent intrafraction reproducibility. CONCLUSION: This study demonstrates that a simple voluntary breath hold technique is feasible in combination with VMAT (+/− bolus) and is as reproducible as ABC_DIBH with VMAT for the irradiation of the breast and axillary and IMC lymph nodes in breast cancer patients. |
format | Online Article Text |
id | pubmed-7918266 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-79182662021-03-05 Voluntary versus ABC breath-hold in the context of VMAT for breast and locoregional lymph node radiotherapy including the internal mammary chain Ranger, Alison Dunlop, Alex Grimwood, Alex Durie, Emily Donovan, Ellen Havilland, Jo Harris, Emma McNair, Helen Kirby, Anna M. Clin Transl Radiat Oncol Article BACKGROUND: Deep-inspiration breath-hold (DIBH) reduces radiation dose to the heart in patients undergoing locoregional breast radiotherapy. In the context of tangential irradiation of the breast/ chest wall, a voluntary breath hold (vDIBH) technique has been shown to be as reproducible as a machine-assisted breath hold technique using the active breathing co-ordinator (ABC™, Elekta, Crawley, UK, ABC_DIBH). This study compares set-up reproducibility for vDIBH versus ABC_DIBH in patients undergoing volumetric-modulated arc radiotherapy (VMAT) for breast cancer, both with and without wax bolus. METHOD: Patients with breast cancer requiring pan regional lymph node VMAT +/− wax bolus in breath-hold were CT scanned in vDIBH and ABC_DIBH. Patients were randomised to receive one technique for fractions 1–7 and the other for fractions 8–15. Daily cone beam computed tomography (CBCT) was performed and registered to planning-CT using bony anatomy. Within-patient comparisons of mean daily chest wall position were made using a paired t-test. Population, systematic (∑) and random errors (α) were estimated. Intrafraction reproducibility was assessed by comparing chest wall position and diaphragm movement between consecutive breath holds on CBCT. RESULTS: 16 patients were recruited. All completed treatment with both techniques (9 patients with wax bolus, 7 patients without). CBCT derived ∑ were 2.1–6.4 mm (ABC_DIBH) and 2.1–4.9 mm (vDIBH), α were 1.7–2.6 mm (ABC_DIBH) and 2.2–2.7 mm (vDIBH) and mean daily chest wall displacements (MD) were 0.0–1.5 mm (ABC_DIBH) and (-)0.1–1.6 vDIBH (all p non-significant). Chest wall and diaphragm position was equivalent between consecutive breath holds in ABC and vDIBH (median difference 1.0 mm and 0.8 mm respectively, non p significant) demonstrating equivalent intrafraction reproducibility. CONCLUSION: This study demonstrates that a simple voluntary breath hold technique is feasible in combination with VMAT (+/− bolus) and is as reproducible as ABC_DIBH with VMAT for the irradiation of the breast and axillary and IMC lymph nodes in breast cancer patients. Elsevier 2021-02-11 /pmc/articles/PMC7918266/ /pubmed/33681483 http://dx.doi.org/10.1016/j.ctro.2021.02.003 Text en © 2021 Published by Elsevier B.V. on behalf of European Society for Radiotherapy and Oncology. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Article Ranger, Alison Dunlop, Alex Grimwood, Alex Durie, Emily Donovan, Ellen Havilland, Jo Harris, Emma McNair, Helen Kirby, Anna M. Voluntary versus ABC breath-hold in the context of VMAT for breast and locoregional lymph node radiotherapy including the internal mammary chain |
title | Voluntary versus ABC breath-hold in the context of VMAT for breast and locoregional lymph node radiotherapy including the internal mammary chain |
title_full | Voluntary versus ABC breath-hold in the context of VMAT for breast and locoregional lymph node radiotherapy including the internal mammary chain |
title_fullStr | Voluntary versus ABC breath-hold in the context of VMAT for breast and locoregional lymph node radiotherapy including the internal mammary chain |
title_full_unstemmed | Voluntary versus ABC breath-hold in the context of VMAT for breast and locoregional lymph node radiotherapy including the internal mammary chain |
title_short | Voluntary versus ABC breath-hold in the context of VMAT for breast and locoregional lymph node radiotherapy including the internal mammary chain |
title_sort | voluntary versus abc breath-hold in the context of vmat for breast and locoregional lymph node radiotherapy including the internal mammary chain |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7918266/ https://www.ncbi.nlm.nih.gov/pubmed/33681483 http://dx.doi.org/10.1016/j.ctro.2021.02.003 |
work_keys_str_mv | AT rangeralison voluntaryversusabcbreathholdinthecontextofvmatforbreastandlocoregionallymphnoderadiotherapyincludingtheinternalmammarychain AT dunlopalex voluntaryversusabcbreathholdinthecontextofvmatforbreastandlocoregionallymphnoderadiotherapyincludingtheinternalmammarychain AT grimwoodalex voluntaryversusabcbreathholdinthecontextofvmatforbreastandlocoregionallymphnoderadiotherapyincludingtheinternalmammarychain AT durieemily voluntaryversusabcbreathholdinthecontextofvmatforbreastandlocoregionallymphnoderadiotherapyincludingtheinternalmammarychain AT donovanellen voluntaryversusabcbreathholdinthecontextofvmatforbreastandlocoregionallymphnoderadiotherapyincludingtheinternalmammarychain AT havillandjo voluntaryversusabcbreathholdinthecontextofvmatforbreastandlocoregionallymphnoderadiotherapyincludingtheinternalmammarychain AT harrisemma voluntaryversusabcbreathholdinthecontextofvmatforbreastandlocoregionallymphnoderadiotherapyincludingtheinternalmammarychain AT mcnairhelen voluntaryversusabcbreathholdinthecontextofvmatforbreastandlocoregionallymphnoderadiotherapyincludingtheinternalmammarychain AT kirbyannam voluntaryversusabcbreathholdinthecontextofvmatforbreastandlocoregionallymphnoderadiotherapyincludingtheinternalmammarychain |