UCLouvain, Institut de Recherche Experimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), 1200 Brussels, Belgium; Radiation Oncology Department, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium.
UCLouvain, Institut de Recherche Experimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), 1200 Brussels, Belgium; Radiation Oncology Department, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium.
Radiother Oncol. 2023 Jun;183:109598. doi: 10.1016/j.radonc.2023.109598. Epub 2023 Mar 9.
Deep inspiration breath-hold (DIBH) protects critical organs-at-risk (OARs) for adjuvant breast radiotherapy. Guidance systems e.g. surface guided radiation therapy (SGRT) improve the positional breast reproducibility and stability during DIBH. In parallel, OARs sparing with DIBH is enhanced through different techniques e.g. prone position, continuous positive airway pressure (CPAP). By inducing repeated DIBH with the same level of positive pressure, mechanically-assisted and non-invasive ventilation (MANIV) could potentially combine these DIBH optimizations.
We conducted a randomized, open-label, multicenter and single-institution non-inferiority trial. Sixty-six patients eligible for adjuvant left whole-breast radiotherapy in supine position were equally assigned between mechanically-induced DIBH (MANIV-DIBH) and voluntary DIBH guided by SGRT (sDIBH). The co-primary endpoints were positional breast stability and reproducibility with a non-inferiority margin of 1 mm. Secondary endpoints were tolerance assessed daily via validated scales, treatment time, dose to OARs and their inter-fraction positional reproducibility.
Differences between both arms for positional breast reproducibility and stability occurred at a sub-millimetric level (p < 0.001 for non-inferiority). The left anterior descending artery near-max dose (14,6 ± 12,0 Gy vs. 7,7 ± 7,1 Gy, p = 0,018) and mean dose (5,0 ± 3,5 Gy vs. 3,0 ± 2,0 Gy, p = 0,009) were improved with MANIV-DIBH. The same applied for the V of the left ventricle (2,4 ± 4,1 % vs. 0,8 ± 1,6 %, p = 0,001) as well as for the left lung V (11,4 ± 2,8 % vs. 9,7 ± 2,7 %, p = 0,019) and V (8,0 ± 2,6 % vs. 6,5 ± 2,3 %, p = 0,0018). Better heart's inter-fraction positional reproducibility was observed with MANIV-DIBH. Tolerance and treatment time were similar.
Mechanical ventilation provides the same target irradiation accuracy as with SGRT while better protecting and repositioning OARs.
深度吸气屏气（DIBH）可保护辅助性乳腺癌放疗的关键危及器官（OAR）。引导系统，如表面引导放疗（SGRT），可提高 DIBH 期间乳房的位置重复性和稳定性。同时，通过不同技术，如俯卧位、持续气道正压通气（CPAP），可增强 DIBH 对 OAR 的保护作用。通过使用相同的正压来诱导重复的 DIBH，机械辅助和非侵入性通气（MANIV）有可能将这些 DIBH 优化结合在一起。
我们开展了一项随机、开放标签、多中心、单机构非劣效性试验。66 例符合左侧全乳放疗仰卧位适应证的患者被平均分配至机械诱导的 DIBH（MANIV-DIBH）和 SGRT 引导的自愿性 DIBH（sDIBH）两组。主要的共同终点是 1mm 的非劣效性边界的位置乳房稳定性和可重复性。次要终点是通过经过验证的量表，每天评估耐受性、治疗时间、OAR 剂量及其分次间位置可重复性。
两组之间的乳房位置可重复性和稳定性差异出现在亚毫米水平（非劣效性 p<0.001）。左前降支的近最大剂量（14.6±12.0 Gy 比 7.7±7.1 Gy，p=0.018）和平均剂量（5.0±3.5 Gy 比 3.0±2.0 Gy，p=0.009）得到改善。左心室 V（2.4±4.1% 比 0.8±1.6%，p=0.001）以及左肺 V（11.4±2.8% 比 9.7±2.7%，p=0.019）和 V（8.0±2.6% 比 6.5±2.3%，p=0.0018）也是如此。与 sDIBH 相比，机械通气更好地保护和重新定位 OAR，可观察到更好的心脏分次间位置可重复性。耐受性和治疗时间相似。
机械通气在提供与 SGRT 相同的靶区照射准确性的同时，还能更好地保护和重新定位 OAR。
