Department of Radiation Oncology, University of Texas Medical Branch, Galveston, TX, USA.
Am J Clin Oncol. 2013 Feb;36(1):24-30. doi: 10.1097/COC.0b013e31823fe481.
Moderate deep inspiration breath-hold (mDIBH), using an Active Breathing Control device, has been used in our clinic since 2002 to reduce cardiac dose for patients receiving left-sided breast irradiation. We report our routine use of the mDIBH technique in clinically localized breast cancer, treated to the intact breast, reconstructed breast, or chest wall.
Ninety-nine patients with left-sided breast cancer were evaluated for Active Breathing Control treatment, of which, 87 patients were treated with mDIBH. Plans for both the free-breathing (FB) and mDIBH computed tomography scans were evaluated. Dose-volume histograms (DVHs) were analyzed for the heart and ipsilateral lung, comparing results for mDIBH versus FB plans.
Eighty-seven patients were included for analysis. Of those, 66% received adjuvant chemotherapy with cardiotoxic agents. The mean dose for the whole breast was 47.6 Gy. There was a statistically significant decrease in all DVH parameters evaluated, favoring the delivery of mDIBH over FB plans. mDIBH plans significantly reduced cardiac mean dose (4.23 vs. 2.54 Gy; P<0.001), a relative reduction of 40%. In addition, there were significant reductions in all other heart parameters evaluated (ie, volume of heart treated, V30, V25, V20, V15, V10, and V5). mDIBH also significantly reduced lung dose, including a reduction of the left lung mean dose (9.08 vs. 7.86 Gy; P<0.001), a relative reduction of 13%, as well as significant reduction of all lung DVH parameters evaluated.
To date, this series represents the largest experience utilizing mDIBH to reduce cardiac irradiation during left-sided breast cancer treatment. Statistically significant reductions in all heart and lung DVH parameters were achieved with mDIBH over FB plans. mDIBH, for the treatment of left-sided breast cancer, is a proven technique for reducing cardiac dose that may lead to reduced cardiotoxicity and can be routinely integrated into the clinic.
自 2002 年以来，我们一直在临床中使用主动呼吸控制（Active Breathing Control，ABC）装置的适度深吸气屏气（moderate deep inspiration breath-hold，mDIBH）来降低接受左侧乳房照射的患者的心脏剂量。我们报告了在接受完整乳房、重建乳房或胸壁照射的临床局限性乳腺癌患者中常规使用 mDIBH 技术的情况。
对 99 例左侧乳腺癌患者进行了主动呼吸控制治疗评估，其中 87 例患者接受了 mDIBH 治疗。评估了自由呼吸（free-breathing，FB）和 mDIBH 计算机断层扫描（computed tomography scan，CT）计划。分析了心脏和同侧肺的剂量-体积直方图（dose-volume histogram，DVH），比较了 mDIBH 与 FB 计划的结果。
87 例患者纳入分析。其中 66%接受了有心脏毒性的辅助化疗。全乳的平均剂量为 47.6Gy。所有评估的 DVH 参数均有统计学意义的降低，支持 mDIBH 优于 FB 计划。mDIBH 计划显著降低了心脏的平均剂量（4.23Gy 对 2.54Gy；P<0.001），相对减少了 40%。此外，所有其他评估的心脏参数均显著降低（即，心脏受照体积、V30、V25、V20、V15、V10 和 V5）。mDIBH 还显著降低了肺剂量，包括左肺平均剂量的降低（9.08Gy 对 7.86Gy；P<0.001），相对减少了 13%，以及所有评估的肺 DVH 参数的显著降低。
迄今为止，该系列代表了使用 mDIBH 降低左侧乳腺癌治疗中心脏照射剂量的最大经验。与 FB 计划相比，mDIBH 可显著降低所有心脏和肺 DVH 参数。mDIBH 是治疗左侧乳腺癌的一种成熟技术，可降低心脏剂量，从而降低心脏毒性，并可常规整合到临床中。
