- 作者：Frederick R. Bartlett ; Ruth M. Colgan ; Karen Carr ; Ellen M. Donovan ; Helen A. McNair ; Imogen Locke ; Philip M. Evans ; Joanne S. Havil ; John R. Yarnold ; Anna M. Kirby
- 关键词：Radiotherapy ; Breast cancer ; Cardiac dose ; Activated breathing control ; Voluntary breath-hold
- 刊名：Radiotherapy and Oncology
- 出版年：2013
- 出版时间：August, 2013
- 年：2013
- 卷：108
- 期：2
- 页码：242-247
- 全文大小：464 K
Purpose
To determine whether voluntary deep-inspiratory breath-hold (v_DIBH) and deep-inspiratory breath-hold with the active breathing coordinator? (ABC_DIBH) in patients undergoing left breast radiotherapy are comparable in terms of normal-tissue sparing, positional reproducibility and feasibility of delivery.Methods
Following surgery for early breast cancer, patients underwent planning-CT scans in v_DIBH and ABC_DIBH. Patients were randomised to receive one technique for fractions 1-7 and the second technique for fractions 8-15 (40 Gy/15 fractions total). Daily electronic portal imaging (EPI) was performed and matched to digitally-reconstructed radiographs. Cone-beam CT (CBCT) images were acquired for 6/15 fractions and matched to planning-CT data. Population systematic (¦²) and random errors (¦Ò) were estimated. Heart, left-anterior-descending coronary artery, and lung doses were calculated. Patient comfort, radiographer satisfaction and scanning/treatment times were recorded. Within-patient comparisons between the two techniques used the paired t-test or Wilcoxon signed-rank test.
Results
Twenty-three patients were recruited. All completed treatment with both techniques. EPI-derived ¦² were ?1.8 mm (v_DIBH) and ?2.0 mm (ABC_DIBH) and ¦Ò ?2.5 mm (v_DIBH) and ?2.2 mm (ABC_DIBH) (all p non-significant). CBCT-derived ¦² were ?3.9 mm (v_DIBH) and ?4.9 mm (ABC_DIBH) and ¦Ò ? 4.1 mm (v_DIBH) and ? 3.8 mm (ABC_DIBH). There was no significant difference between techniques in terms of normal-tissue doses (all p non-significant). Patients and radiographers preferred v_DIBH (p = 0.007, p = 0.03, respectively). Scanning/treatment setup times were shorter for v_DIBH (p = 0.02, p = 0.04, respectively).
Conclusions
v_DIBH and ABC_DIBH are comparable in terms of positional reproducibility and normal tissue sparing. v_DIBH is preferred by patients and radiographers, takes less time to deliver, and is cheaper than ABC_DIBH.