Department of Radiation Oncology, Unit 3. Christian Medical College, Vellore, Tamil Nadu, India.
Department of Radiation Oncology, Evercare Hospital, Chattogram, Bangladesh.
Asian Pac J Cancer Prev. 2024 Sep 1;25(9):3301-3310. doi: 10.31557/APJCP.2024.25.9.3301.
In the context of left breast cancer radiotherapy, long term cardiopulmonary toxicity has been well-documented, significant efforts have been undertaken to mitigate such toxicity by using 4D gating, deep inspiration breath-hold(DIBH) and active breath control(ABC) techniques.
To evaluate and compare the cardio-pulmonary radiation doses incurred during postmastectomy radiotherapy (PMRT) in two distinct breathing conditions such as DIBH and Free Breathing (FB), with a specific focus on the left chest wall with comprehensive regional nodal irradiation.
A prospective dosimetric study was conducted on 15 patients who received adjuvant loco-regional radiotherapy of chest-wall (CW), supraclavicular fossa(SCF), and internal mammary region(IMC), with or without axilla. Two sets of planning CT scans were taken in DIBH and FB conditions. The dosimetric difference between DIBH CT and FB CT plans analyzed using Wilcoxon signed-rank test, employing SPSS software version 21.0.
Comparison of DIBH and FB parameters for target coverage revealed a statistically significant advantage with DIBH in SCF(D95, V90, p<0.017) and IMC(D98, V90 & V95, p<0.03). Dosimetric characteristics of heart and LAD exhibited statistically significant lower doses with DIBH (V20, V25, and Dmean, p<0.001) compared to FB plans. Lung doses were similar with no discernible advantage of one technique over the other. Other OARs such as contralateral breast (p=0.027) and esophagus (p=0.001) received lower doses with the DIBH technique while the spinal cord (p=0.691) and thyroid(p=0.496) showed no significant difference. Maximum heart distance (p= 0.001), central lung distance (p= 0.011) and Haller index (p= 0.001) exhibited statistical significance between the two techniques, whereas chest wall separation showed no significant statistical difference (p=0.629).
DIBH demonstrates a substantial reduction in cardiac and LAD doses compared to the FB technique. This study underscores the efficacy of DIBH as a viable strategy for mitigating cardiac and LAD radiation doses in left-sided breast cancer patients undergoing PMRT of chest wall with comprehensive regional nodes.
在左侧乳腺癌放射治疗的背景下，长期心肺毒性已得到充分证实，已采取重大努力通过使用 4D 门控、深吸气屏气（DIBH）和主动呼吸控制（ABC）技术来减轻这种毒性。
评估并比较两种不同呼吸状态（DIBH 和自由呼吸（FB））下，在接受胸壁（CW）、锁骨上窝（SCF）和内乳区（IMC）区域辅助局部放疗的改良根治术后患者中，左胸壁区域全面区域淋巴结照射的心肺放射剂量。
对 15 例接受 CW、SCF 和 IMC 区域辅助局部放疗，或同时加腋窝区域放疗的改良根治术后患者进行前瞻性剂量学研究。在 DIBH 和 FB 条件下采集两组计划 CT 扫描。使用 SPSS 软件版本 21.0，采用 Wilcoxon 符号秩检验对 DIBH CT 和 FB CT 计划的剂量学差异进行分析。
靶区覆盖的 DIBH 和 FB 参数比较显示，在 SCF（D95、V90，p<0.017）和 IMC（D98、V90 和 V95，p<0.03）中，DIBH 具有统计学显著优势。与 FB 计划相比，DIBH 组心脏和 LAD 的剂量学特征表现出明显较低的剂量（V20、V25 和 Dmean，p<0.001）。肺剂量相似，两种技术之间没有明显的优势。其他 OAR 如对侧乳房（p=0.027）和食管（p=0.001）接受的剂量较低，而脊髓（p=0.691）和甲状腺（p=0.496）则无明显差异。两种技术之间的最大心脏距离（p=0.001）、中央肺距离（p=0.011）和 Haller 指数（p=0.001）具有统计学意义，而胸壁分离无明显统计学差异（p=0.629）。
与 FB 技术相比，DIBH 可显著降低心脏和 LAD 剂量。这项研究强调了 DIBH 作为一种可行策略的功效，可降低接受左乳腺癌改良根治术后 CW 区域全面区域淋巴结照射的患者的心脏和 LAD 辐射剂量。
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