常规使用中度深吸气屏气技术降低早期或局部晚期乳腺癌左侧乳房放疗中心脏剂量：6 年经验总结。
Six-year experience routinely using moderate deep inspiration breath-hold for the reduction of cardiac dose in left-sided breast irradiation for patients with early-stage or locally advanced breast cancer.
机构信息
Department of Radiation Oncology, University of Texas Medical Branch, Galveston, TX, USA.
出版信息
Am J Clin Oncol. 2013 Feb;36(1):24-30. doi: 10.1097/COC.0b013e31823fe481.
PURPOSE
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.
MATERIALS AND METHODS
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.
RESULTS
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.
CONCLUSIONS
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.
目的
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。
材料和方法
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。
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。
结论
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。
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