深吸气屏气（DIBH）技术在左侧乳腺癌中的应用：临床实用性的各个方面。
Deep-inspirational breath-hold (DIBH) technique in left-sided breast cancer: various aspects of clinical utility.
机构信息
Department of Oncotherapy, University of Szeged, Korányi fasor 12, 6720, Szeged, Hungary.
出版信息
Radiat Oncol. 2021 May 13;16(1):89. doi: 10.1186/s13014-021-01816-3.
BACKGROUND
Studying the clinical utility of deep-inspirational breath-hold (DIBH) in left breast cancer radiotherapy (RT) was aimed at focusing on dosimetry and feasibility aspects.
METHODS
In this prospective trial all enrolled patients went through planning CT in supine position under both DIBH and free breathing (FB); in whole breast irradiation (WBI) cases prone CT was also taken. In 3-dimensional conformal radiotherapy (3DCRT) plans heart, left anterior descending coronary artery (LAD), ipsilateral lung and contralateral breast doses were analyzed. The acceptance of DIBH technique as reported by the patients and the staff was analyzed; post-RT side-effects including radiation lung changes (visual scores and lung density measurements) were collected.
RESULTS
Among 130 enrolled patients 26 were not suitable for the technique while in 16, heart or LAD dose constraints were not met in the DIBH plans. Among 54 and 34 patients receiving WBI and postmastectomy/nodal RT, respectively with DIBH, mean heart dose (MHD) was reduced to < 50%, the heart V to < 20%, the LAD mean dose to < 40% and the LAD maximum dose to about 50% as compared to that under FB; the magnitude of benefit was related to the relative increase of the ipsilateral lung volume at DIBH. Nevertheless, heart and LAD dose differences (DIBH vs. FB) individually varied. Among the WBI cases at least one heart/LAD dose parameter was more favorable in the prone or in the supine FB plan in 15 and 4 cases, respectively; differences were numerically small. All DIBH patients completed the RT, inter-fraction repositioning accuracy and radiation side-effects were similar to that of other breast RT techniques. Both the patients and radiographers were satisfied with the technique.
CONCLUSIONS
DIBH is an excellent heart sparing technique in breast RT, but about one-third of the patients do not benefit from that otherwise laborious procedure or benefit less than from an alternative method.
TRIAL REGISTRATION
retrospectively registered under ISRCTN14360721 (February 12, 2021).
背景
研究深吸气屏气（DIBH）在左乳腺癌放疗（RT）中的临床应用，旨在关注剂量学和可行性方面。
方法
在这项前瞻性试验中，所有入组患者均在 DIBH 和自由呼吸（FB）下接受仰卧位计划 CT；在全乳照射（WBI）病例中还进行了俯卧位 CT。在 3 维适形放疗（3DCRT）计划中，分析心脏、左前降支冠状动脉（LAD）、同侧肺和对侧乳房的剂量。分析患者和工作人员对 DIBH 技术的接受程度；收集放疗后副作用，包括放射性肺改变（视觉评分和肺密度测量）。
结果
在 130 名入组患者中，有 26 名患者不适合该技术，而在 16 名患者中，DIBH 计划中心脏或 LAD 剂量限制未得到满足。在 54 名和 34 名分别接受 WBI 和乳房切除术后/淋巴结 RT 并采用 DIBH 的患者中，与 FB 相比，平均心脏剂量（MHD）降低至<50%，心脏 V 降至<20%，LAD 平均剂量降至<40%，LAD 最大剂量降至约 50%；受益程度与 DIBH 时同侧肺体积的相对增加有关。然而，心脏和 LAD 剂量差异（DIBH 与 FB）因人而异。在 WBI 病例中，在俯卧或仰卧 FB 计划中，至少有一个心脏/LAD 剂量参数更有利的病例分别为 15 例和 4 例；差异数值较小。所有 DIBH 患者均完成 RT，分次间重新定位准确性和放射副作用与其他乳房 RT 技术相似。患者和放射技师都对该技术感到满意。
结论
DIBH 是乳腺癌 RT 中一种出色的心脏保护技术，但约有三分之一的患者不能从这种费力的操作中受益，或者受益程度低于替代方法。
试验注册
于 2021 年 2 月 12 日在 ISRCTN 注册（ISRCTN82552015）。
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