Mulliez Thomas, Veldeman Liv, Speleers Bruno, Mahjoubi Khalil, Remouchamps Vincent, Van Greveling Annick, Gilsoul Monique, Berwouts Dieter, Lievens Yolande, Van den Broecke Rudy, De Neve Wilfried
Department of Radiotherapy, Ghent University Hospital, Belgium; Department of Radiotherapy, Clinique et Maternité Sainte-Elisabeth, Namur, Belgium.
Department of Radiotherapy, Ghent University Hospital, Belgium.
Radiother Oncol. 2015 Jan;114(1):79-84. doi: 10.1016/j.radonc.2014.11.038. Epub 2014 Dec 9.
Cardiac disease has been related to heart dose after left-sided breast radiotherapy. This trial evaluates the heart sparing ability and feasibility of deep inspiration breath hold (DIBH) in the prone position for left-sided whole breast irradiation (WBI).
Twelve patients underwent CT-simulation in supine shallow breathing (SB), supine DIBH, prone SB and prone DIBH. A validation cohort of 38 patients received prone SB and prone DIBH CT-scans; the last 30 patients were accepted for prone DIBH treatment. WBI was planned with a prescription dose of 40.05 Gy.
DIBH was able to reduce (p<0.001) heart dose in both positions, with results for prone DIBH at least as favorable as for supine DIBH. Mean heart dose was lowered from 2.2 Gy for prone SB to 1.3 Gy for prone DIBH (p<0.001), while preserving the lung sparing ability of prone positioning. Moreover prone DIBH nearly consistently reduced mean heart dose to less then 2 Gy, regardless of breast volume. All patients were able to perform the simulation procedure, 28/30 patients were treated with prone DIBH.
This trial demonstrates the ability and feasibility of prone DIBH to acquire optimal heart and lung sparing for left-sided WBI.
心脏病与左侧乳腺放疗后的心脏剂量相关。本试验评估了俯卧位深呼吸屏气（DIBH）在左侧全乳照射（WBI）中保护心脏的能力及可行性。
12例患者分别在仰卧位浅呼吸（SB）、仰卧位DIBH、俯卧位SB和俯卧位DIBH状态下接受CT模拟。38例患者的验证队列接受了俯卧位SB和俯卧位DIBH的CT扫描；最后30例患者接受俯卧位DIBH治疗。WBI计划处方剂量为40.05 Gy。
DIBH在两种体位下均能降低（p<0.001）心脏剂量，俯卧位DIBH的结果至少与仰卧位DIBH一样好。平均心脏剂量从俯卧位SB的2.2 Gy降至俯卧位DIBH的1.3 Gy（p<0.001），同时保留了俯卧位的肺保护能力。此外，无论乳腺体积如何，俯卧位DIBH几乎始终将平均心脏剂量降低至2 Gy以下。所有患者均能完成模拟程序，28/30例患者接受了俯卧位DIBH治疗。
本试验证明了俯卧位DIBH在左侧WBI中获得最佳心脏和肺保护的能力及可行性。
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