腹部 DIBH 进一步降低心脏剂量：一项前瞻性分析。
Abdominal DIBH reduces the cardiac dose even further: a prospective analysis.
机构信息
Department of Radiation Oncology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, People's Republic of China.
Department of Radiation Oncology, Yiwu Central Hospital, Yiwu, Zhejiang, 322000, People's Republic of China.
出版信息
Radiat Oncol. 2018 Jun 22;13(1):116. doi: 10.1186/s13014-018-1062-6.
BACKGROUND
Deep inspiration breath hold (DIBH) can be performed using different breathing maneuvers, such as DIBH with a thoracic breathing maneuver (T-DIBH) and DIBH with an abdominal breathing maneuver (A-DIBH). Dosimetric benefits of A-DIBH were investigated in the treatment of left-sided breast cancer radiotherapy (RT) with both 3-Dimensional conformal radiation therapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) techniques.
METHODS
Twenty-two patients with left-sided breast cancer were enrolled in this study. 3D-CRT and IMRT plans were generated for each patient with three different CT scans of free breathing (FB), T-DIBH and A-DIBH. There were total of six treatment plans generated for each patient: FB_3D-CRT; TDIBH_3D-CRT; ADIBH_3D-CRT; FB-IMRT; TDIBH-IMRT; ADIBH-IMRT. Doses to the heart, left anterior descending coronary artery (LADCA), and ipsilateral lung were evaluated and compared using the Wilcoxon signed-rank test.
RESULTS
The mean doses to the heart, LADCA and ipsilateral lung in 3D-CRT plans generated from 3D-CRT with FB, T-DIBH and A-DIBH were (2.89 ± 1.30), (1.67 ± 0.90) and (1.34 ± 0.43) Gy (all P < 0.05), respectively, with FB; (29.08 ± 16.72), (13.94 ± 14.74) and (10.22 ± 10.30) Gy (all P < 0.05), respectively, with T-DIBH; and (7.77 ± 2.71), (7.32 ± 1.42) and (6.90 ± 1.60) Gy (all P < 0.05), respectively, with A-DIBH. The mean doses to the heart, LADCA and ipsilateral lung in IMRT plans were generated from IMRT with FB, T-DIBH and A-DIBH were (1.96 ± 2.25), (1.37 ± 0.44) and (1.18 ± 0.26) Gy (all P < 0.05), respectively, with FB; (16.10 ± 7.45), (8.6 ± 6.60) and (7.35 ± 5.42) Gy (all P < 0.05), respectively, with T-DIBH; and (5.90 ± 2.24), (5.65 ± 1.58) and (5.62 ± 1.05) Gy (all P > 0.05), respectively, with A-DIBH.
CONCLUSIONS
This study indicates that both 3D-CRT and IMRT plans with A-DIBH achieved lower cardiac and LADCA doses than plans with FB and T-DIBH; 3D-CRT plans with A-DIBH achieved lower ipsilateral lung doses than plans with FB and T-DIBH; and IMRT plans with A-DIBH had better outcomes than 3D-CRT plans with A-DIBH with respect to the mean dose to the heart, LADCA and ipsilateral lung. IMRT plans with A-DIBH should be incorporated into the daily routine for left-sided breast RT.
背景
深吸气屏气（DIBH）可以使用不同的呼吸动作来进行，例如使用胸式呼吸动作（T-DIBH）的 DIBH 和使用腹式呼吸动作（A-DIBH）的 DIBH。使用三维适形放疗（3D-CRT）和调强放疗（IMRT）技术治疗左侧乳腺癌放疗（RT）时，已经研究了 A-DIBH 的剂量学优势。
方法
本研究纳入了 22 例左侧乳腺癌患者。为每位患者生成了三种不同的自由呼吸（FB）、T-DIBH 和 A-DIBH 的 CT 扫描的 3D-CRT 和 IMRT 计划。每位患者共有 6 个治疗计划：FB_3D-CRT；TDIBH_3D-CRT；ADIBH_3D-CRT；FB-IMRT；TDIBH-IMRT；ADIBH-IMRT。使用 Wilcoxon 符号秩检验评估和比较心脏、左前降支（LADCA）和同侧肺的剂量。
结果
3D-CRT 计划中，FB、T-DIBH 和 A-DIBH 生成的 3D-CRT 计划中心脏、LADCA 和同侧肺的平均剂量分别为（2.89±1.30）、（1.67±0.90）和（1.34±0.43）Gy（均 P<0.05）；FB 分别为（29.08±16.72）、（13.94±14.74）和（10.22±10.30）Gy（均 P<0.05）；FB 分别为（7.77±2.71）、（7.32±1.42）和（6.90±1.60）Gy（均 P<0.05）。IMRT 计划中，FB、T-DIBH 和 A-DIBH 生成的 IMRT 计划中心脏、LADCA 和同侧肺的平均剂量分别为（1.96±2.25）、（1.37±0.44）和（1.18±0.26）Gy（均 P<0.05）；FB 分别为（16.10±7.45）、（8.6±6.60）和（7.35±5.42）Gy（均 P<0.05）；FB 分别为（5.90±2.24）、（5.65±1.58）和（5.62±1.05）Gy（均 P>0.05）。
结论
本研究表明，与 FB 和 T-DIBH 相比，使用 A-DIBH 的 3D-CRT 和 IMRT 计划可降低心脏和 LADCA 的剂量；与 FB 和 T-DIBH 相比，A-DIBH 的 3D-CRT 计划可降低同侧肺的剂量；与 A-DIBH 的 3D-CRT 计划相比，A-DIBH 的 IMRT 计划可降低心脏、LADCA 和同侧肺的平均剂量。对于左侧乳腺癌 RT，应将 A-DIBH 的 IMRT 计划纳入日常工作。
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