Schönecker S, Angelini L, Gaasch A, Zinn A, Konnerth D, Heinz C, Xiong Y, Unger K, Landry G, Meattini I, Braun M, Pölcher M, Harbeck N, Würstlein R, Niyazi M, Belka C, Pazos M, Corradini S
Department of Radiation Oncology, University Hospital LMU Munich, Munich, Germany; Bavarian Cancer Research Center (BZKF), Munich, Germany.
Department of Radiation Oncology, University Hospital LMU Munich, Munich, Germany; Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy.
ESMO Open. 2024 Dec;9(12):103993. doi: 10.1016/j.esmoop.2024.103993. Epub 2024 Dec 3.
Adjuvant radiotherapy (RT) plays an essential role in the management of early breast cancer (BC), but can lead to cardiovascular and lung toxicities. RT in deep inspiration breath hold (DIBH) often allows better protection of organs at risk. This prospective study compares surface-guided DIBH with free breathing (FB) in patients with left-sided BC, by evaluating individual cardiovascular risks and treatment plan dosimetry.
The study enrolled 585 patients from October 2016 to January 2021 with left-sided invasive breast carcinoma with indicated adjuvant RT of the breast/thoracic wall with or without regional lymph nodes. The ability to hold breath for 20 s was a prerequisite. The treatments were either hypofractionated (HF; 40.05 Gy/15Fx) or normofractionated (NF; 50.00 Gy/25Fx). DIBH was applied using the automatically triggered surface guidance system Catalyst with audio-video feedback. Computed tomography and surface data were acquired during both DIBH and FB. The primary endpoint of the study was the comparative evaluation of heart dose reduction using DIBH.
Plan dosimetry was significantly improved by DIBH. The mean and maximum doses to the heart and the left coronary artery were significantly reduced by 36%-42% in HF and NF plans (P < 0.001), while the mean ipsilateral lung dose was reduced by 12%-14% (P < 0.001). Furthermore, DIBH resulted in a 5% reduction in the cumulative 10-year cardiovascular disease risk (10-year cardiovascular disease risk) compared with FB (3.59% to 3.41%; P < 0.001).
To the best of our knowledge, this is the largest prospective study showing better sparing for cardiac and ipsilateral lung doses with surface-guided DIBH compared with FB in patients with left-sided BC.
辅助放疗在早期乳腺癌（BC）的治疗中起着至关重要的作用，但可能导致心血管和肺部毒性。深吸气屏气（DIBH）放疗通常能更好地保护危及器官。本前瞻性研究通过评估个体心血管风险和治疗计划剂量测定，比较左侧乳腺癌患者表面引导下的DIBH与自由呼吸（FB）。
本研究纳入了2016年10月至2021年1月的585例左侧浸润性乳腺癌患者，这些患者需接受乳房/胸壁的辅助放疗，有或无区域淋巴结照射。能够屏气20秒是一个前提条件。治疗方案为大分割放疗（HF；40.05 Gy/15次分割）或常规分割放疗（NF；50.00 Gy/25次分割）。使用带有视听反馈的自动触发表面引导系统Catalyst进行DIBH。在DIBH和FB期间均采集计算机断层扫描和表面数据。本研究的主要终点是使用DIBH对心脏剂量降低的比较评估。
DIBH显著改善了计划剂量测定。在HF和NF计划中，心脏和左冠状动脉的平均剂量和最大剂量显著降低了36%-42%（P<0.001），而同侧肺平均剂量降低了12%-14%（P<0.001）。此外，与FB相比，DIBH使累积10年心血管疾病风险降低了5%（10年心血管疾病风险从3.59%降至3.41%；P<0.001）。
据我们所知，这是最大的前瞻性研究，表明在左侧乳腺癌患者中，与FB相比，表面引导下的DIBH对心脏和同侧肺剂量有更好的保护作用。
