Department of Radiation Oncology, WellSpan Health, Chambersburg, PA.
Department of Radiation Oncology, Gangnam Severance Hospital, College of Medicine, Yonsei University, Seoul, Korea.
Am J Clin Oncol. 2019 Oct;42(10):797-801. doi: 10.1097/COC.0000000000000597.
The purpose of this study was to report experiences of practical heart sparing breast radiation therapy (RT) using continuous positive airway pressure (CPAP) in resource-limited radiation oncology clinics.
Twelve patients underwent computed tomography-simulations with both free-breathing (FB) and CPAP under the individual maximum tolerable air pressure. For each patient, left-sided breast RT plans (9 with breast only, 3 with breast and regional nodal stations) with FB and CPAP were created using 3-dimensional conformal RT (supine tangential or wide tangential RT fields) according to RTOG 1304. For daily RT, patients started CPAP in the patients waiting area for 15 minutes before entering the treatment room and continued CPAP during RT. Treatment setup times between breast RT with and without CPAP were compared.
All patients tolerated CPAP well with 8 to 15 cm H2O of air pressure. Compared with FB, CPAP inflated the thorax and increased total lung volume by 35±16% (CPAP: 3136±751 vs. FB: 2354±657 cm, P<0.01); caudally displaced the heart by 1.8 cm (P<0.01); and decreased heart volume within tangential RT fields on computed tomography-simulation scans by 96±4% (1.4±2.5 vs. 21±17 cm, P=0.02) in all patients. Planning target volume coverage was acceptable in all RT plans. CPAP lowered mean dose (Dmean) to heart by 47±22% (2.5±1.5 vs. 5.4±3.3 Gy, P<0.01); heart volume receiving ≥25 Gy (V25) by 82±18% (2.2±2.6 vs. 9.1±7.1%, P<0.01); Dmean to left anterior descending coronary artery by 68±8% (4.7±1.9 vs. 14.8±3.3 Gy, P<0.01). CPAP decreased radiation dose to ipsilateral lung compared with FB: 9.1±5.8 versus 11.2±8 Gy (20% reduction, P=0.03) of Dmean; 15.7±12.5 vs. 20.5±17.5% (25% reduction, P=0.03) of V20. RT with CPAP did not increase treatment setup time compared with FB (week 1: 362±63 vs. 352±77 s; week 2 to 5: 217±13 vs. 201±14 s, all P>0.25).
Novel use of CPAP allowed efficient and practical heart sparing breast RT without increasing infrastructural requirements in resource-limited radiation oncology clinics.
本研究旨在报告在资源有限的放射肿瘤学临床中使用持续气道正压通气（CPAP）进行实用的心脏保护乳房放疗（RT）的经验。
12 名患者在个人最大耐受气压下进行了自由呼吸（FB）和 CPAP 的计算机断层扫描模拟。对于每位患者，使用 3 维适形 RT（仰卧切线或宽切线 RT 场）根据 RTOG 1304 为 FB 和 CPAP 分别创建了左侧乳房 RT 计划（9 个仅乳房，3 个乳房和区域淋巴结站）。对于日常 RT，患者在进入治疗室前在等候区使用 CPAP 通气 15 分钟，并在 RT 期间继续使用 CPAP。比较了有 CPAP 和无 CPAP 的乳房 RT 的治疗设置时间。
所有患者均能很好地耐受 CPAP，空气压力为 8 至 15cmH2O。与 FB 相比，CPAP 使胸部充气并使总肺容量增加 35±16%（CPAP：3136±751 vs. FB：2354±657cm，P<0.01）；将心脏向下移位 1.8cm（P<0.01）；并在所有患者的 CT 模拟扫描上使切线 RT 场中的心脏体积减少 96±4%（1.4±2.5 vs. 21±17cm，P=0.02）。所有 RT 计划的靶区覆盖均可接受。CPAP 将心脏的平均剂量（Dmean）降低了 47±22%（2.5±1.5 vs. 5.4±3.3Gy，P<0.01）；心脏体积接受≥25Gy（V25）降低了 82±18%（2.2±2.6 vs. 9.1±7.1%，P<0.01）；左前降支冠状动脉的 Dmean 降低了 68±8%（4.7±1.9 vs. 14.8±3.3Gy，P<0.01）。CPAP 使同侧肺的放射剂量与 FB 相比降低：Dmean 为 9.1±5.8 比 11.2±8Gy（降低 20%，P=0.03）；V20 为 15.7±12.5 比 20.5±17.5%（降低 25%，P=0.03）。与 FB 相比，CPAP 进行 RT 不会增加治疗设置时间（第 1 周：362±63 比 352±77s；第 2 至 5 周：217±13 比 201±14s，均 P>0.25）。
在资源有限的放射肿瘤学临床中，CPAP 的新应用可实现高效且实用的心脏保护乳房 RT，而无需增加基础设施要求。
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