Bartlett F R, Donovan E M, McNair H A, Corsini L A, Colgan R M, Evans P M, Maynard L, Griffin C, Haviland J S, Yarnold J R, Kirby A M
Department of Radiotherapy, Royal Marsden NHS Foundation Trust, Sutton, UK; Department of Oncology and Haematology, Queen Alexandra Hospital, Portsmouth, UK.
Joint Department of Physics, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, UK.
Clin Oncol (R Coll Radiol). 2017 Mar;29(3):e51-e56. doi: 10.1016/j.clon.2016.11.005. Epub 2016 Nov 24.
To evaluate the feasibility and heart-sparing ability of the voluntary breath-hold (VBH) technique in a multicentre setting.
Patients were recruited from 10 UK centres. Following surgery for early left breast cancer, patients with any heart inside the 50% isodose from a standard free-breathing tangential field treatment plan underwent a second planning computed tomography (CT) scan using the VBH technique. A separate treatment plan was prepared on the VBH CT scan and used for treatment. The mean heart, left anterior descending coronary artery (LAD) and lung doses were calculated. Daily electronic portal imaging (EPI) was carried out and scanning/treatment times were recorded. The primary end point was the percentage of patients achieving a reduction in mean heart dose with VBH. Population systematic (Σ) and random errors (σ) were estimated. Within-patient comparisons between techniques used Wilcoxon signed-rank tests.
In total, 101 patients were recruited during 2014. Primary end point data were available for 93 patients, 88 (95%) of whom achieved a reduction in mean heart dose with VBH. Mean cardiac doses (Gy) for free-breathing and VBH techniques, respectively, were: heart 1.8 and 1.1, LAD 12.1 and 5.4, maximum LAD 35.4 and 24.1 (all P<0.001). Population EPI-based displacement data showed Σ =+1.3-1.9 mm and σ=1.4-1.8 mm. Median CT and treatment session times were 21 and 22 min, respectively.
The VBH technique is confirmed as effective in sparing heart tissue and is feasible in a multicentre setting.
在多中心环境中评估自主屏气（VBH）技术的可行性和心脏保护能力。
从英国10个中心招募患者。早期左乳腺癌手术后，对于标准自由呼吸切线野治疗计划中50%等剂量线内包含任何心脏的患者，使用VBH技术进行第二次计划计算机断层扫描（CT）。在VBH CT扫描上制定单独的治疗计划并用于治疗。计算心脏、左前降支冠状动脉（LAD）和肺部的平均剂量。进行每日电子门静脉成像（EPI）并记录扫描/治疗时间。主要终点是使用VBH使平均心脏剂量降低的患者百分比。估计总体系统误差（Σ）和随机误差（σ）。技术之间的患者内比较采用Wilcoxon符号秩检验。
2014年共招募了101例患者。93例患者有主要终点数据，其中88例（95%）使用VBH后平均心脏剂量降低。自由呼吸和VBH技术的平均心脏剂量（Gy）分别为：心脏1.8和1.1，LAD 12.1和5.4，最大LAD 35.4和24.1（所有P<0.001）。基于总体EPI的位移数据显示Σ = +1.3 - 1.9 mm且σ = 1.4 - 1.8 mm。CT和治疗疗程的中位时间分别为21分钟和22分钟。
VBH技术被证实对保护心脏组织有效，且在多中心环境中可行。
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