Eldredge-Hindy Harriet, Lockamy Virginia, Crawford Albert, Nettleton Virginia, Werner-Wasik Maria, Siglin Joshua, Simone Nicole L, Sidhu Kulbir, Anne Pramila R
Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania.
Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania.
Pract Radiat Oncol. 2015 Jan-Feb;5(1):4-10. doi: 10.1016/j.prro.2014.06.004.
Incidental radiation dose to the heart and lung during breast radiation therapy (RT) has been associated with an increased risk of cardiopulmonary morbidity. We conducted a prospective trial to determine if RT with the Active Breathing Coordinator (ABC) can reduce the mean heart dose (MHD) by ≥20% and dose to the lung.
Patients with stages 0-III left breast cancer (LBC) were enrolled and underwent simulation with both free breathing (FB) and ABC for comparison of dosimetry. ABC was used during the patient's RT course if the MHD was reduced by ≥5%. The median prescription dose was 50.4 Gy plus a boost in 77 patients (90%). The primary endpoint was the magnitude of MHD reduction when comparing ABC to FB. Secondary endpoints included dose reduction to the heart and lung, procedural success rate, and adverse events.
A total of 112 patients with LBC were enrolled from 2002 to 2011 and 86 eligible patients underwent both FB and ABC simulation. Ultimately, 81 patients received RT using ABC, corresponding to 72% procedural success. The primary endpoint was achieved as use of ABC reduced MHD by 20% or greater in 88% of patients (P < .0001). The median values for absolute and relative reduction in MHD were 1.7 Gy and 62%, respectively. RT with ABC provided a statistically significant dose reduction to the left lung. After a median follow up of 81 months, 8-year estimates of locoregional relapse, disease-free, and overall survival were 7%, 90%, and 96%, respectively.
ABC was well tolerated and significantly reduced MHD while preserving local control. Use of the ABC device during RT should be considered to reduce the risk of ischemic heart disease in populations at risk.
乳腺癌放射治疗（RT）期间心脏和肺部的附带辐射剂量与心肺疾病发病率增加有关。我们进行了一项前瞻性试验，以确定使用主动呼吸协调器（ABC）进行放疗是否能将平均心脏剂量（MHD）降低≥20%以及肺部剂量。
纳入0-III期左乳腺癌（LBC）患者，进行自由呼吸（FB）和ABC模拟以比较剂量测定。如果MHD降低≥5%，则在患者放疗过程中使用ABC。77例患者（90%）接受中位处方剂量50.4 Gy加推量照射。主要终点是比较ABC与FB时MHD降低的幅度。次要终点包括心脏和肺部剂量降低、操作成功率及不良事件。
2002年至2011年共纳入112例LBC患者，86例符合条件的患者接受了FB和ABC模拟。最终，81例患者使用ABC进行放疗，操作成功率为72%。主要终点达成，因为使用ABC使88%的患者MHD降低20%或更多（P <.0001）。MHD绝对降低和相对降低的中位值分别为1.7 Gy和62%。使用ABC进行放疗使左肺剂量有统计学意义地降低。中位随访81个月后，局部区域复发、无病生存和总生存的8年估计分别为7%、90%和96%。
ABC耐受性良好，在保持局部控制的同时显著降低了MHD。放疗期间应考虑使用ABC装置以降低高危人群患缺血性心脏病的风险。
