Bartlett Frederick R, Colgan Ruth M, Carr Karen, Donovan Ellen M, McNair Helen A, Locke Imogen, Evans Philip M, Haviland Joanne S, Yarnold John R, Kirby Anna M
Department of Academic Radiotherapy, Royal Marsden NHS Foundation Trust, Sutton, UK.
Radiother Oncol. 2013 Aug;108(2):242-7. doi: 10.1016/j.radonc.2013.04.021. Epub 2013 May 29.
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.
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 (Σ) and random errors (σ) 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.
Twenty-three patients were recruited. All completed treatment with both techniques. EPI-derived Σ were ≤ 1.8mm (v_DIBH) and ≤ 2.0mm (ABC_DIBH) and σ ≤ 2.5mm (v_DIBH) and ≤ 2.2mm (ABC_DIBH) (all p non-significant). CBCT-derived Σ were ≤ 3.9 mm (v_DIBH) and ≤ 4.9 mm (ABC_DIBH) and σ ≤ 4.1mm (v_DIBH) and ≤ 3.8mm (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).
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.
确定在接受左乳放疗的患者中，自主深吸气屏气（v_DIBH）与使用主动呼吸协调器™（ABC_DIBH）进行深吸气屏气在正常组织保护、位置重复性和实施可行性方面是否具有可比性。
早期乳腺癌患者术后，分别在v_DIBH和ABC_DIBH状态下进行计划CT扫描。患者被随机分配，在第1 - 7次分割放疗中接受一种技术，在第8 - 15次分割放疗中接受另一种技术（总计40 Gy/15次分割）。每日进行电子射野成像（EPI），并与数字重建射线照片匹配。在15次分割中的6次获取锥束CT（CBCT）图像，并与计划CT数据匹配。估计总体系统误差（Σ）和随机误差（σ）。计算心脏、左前降支冠状动脉和肺部的剂量。记录患者舒适度、放射技师满意度以及扫描/治疗时间。两种技术在患者内的比较采用配对t检验或Wilcoxon符号秩检验。
招募了23名患者。所有患者均完成了两种技术的治疗。EPI得出的Σ在v_DIBH中≤1.8mm，在ABC_DIBH中≤2.0mm，σ在v_DIBH中≤2.5mm，在ABC_DIBH中≤2.2mm（所有p值均无统计学意义）。CBCT得出的Σ在v_DIBH中≤3.9mm，在ABC_DIBH中≤4.9mm；σ在v_DIBH中≤4.1mm，在ABC_DIBH中≤3.8mm。两种技术在正常组织剂量方面无显著差异（所有p值均无统计学意义）。患者和放射技师更倾向于v_DIBH（分别为p = =0.007，p = 0.03）。v_DIBH的扫描/治疗设置时间更短（分别为p = 0.02，p = 0.04）。
v_DIBH和ABC_DIBH在位置重复性和正常组织保护方面具有可比性。v_DIBH更受患者和放射技师青睐，实施时间更短，且比ABC_DIBH成本更低。
