Six-year experience routinely using moderate deep inspiration breath-hold for the reduction of cardiac dose in left-sided breast irradiation for patients with early-stage or locally advanced breast cancer.
Six-year experience routinely using moderate deep inspiration breath-hold for the reduction of cardiac dose in left-sided breast irradiation for patients with early-stage or locally advanced breast cancer.
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DOI：
10.1097/coc.0b013e31823fe481
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发表时间：
2013-02
期刊：
影响因子：
--
通讯作者：
Vicini FA
中科院分区：
文献类型：
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作者：
Swanson T;Grills IS;Ye H;Entwistle A;Teahan M;Letts N;Yan D;Duquette J;Vicini FA
自2002年以来，我们的诊所一直在使用中度深吸气屏气（mDIBH），利用主动呼吸控制（ABC）装置，以减少接受左侧乳房照射的患者的心脏剂量。我们报告我们的常规使用mDIBH技术在临床局部乳腺癌，治疗完整的乳房，再造乳房，或胸壁。99例左侧乳腺癌患者接受ABC治疗，其中87例患者接受mDIBH治疗。评价了自由呼吸（FB）和mDIBH CT扫描的计划。分析心脏和同侧肺的剂量体积直方图（DVH），比较mDIBH与FB计划的结果。87例患者纳入分析。其中，66%的患者接受了心脏毒性药物的辅助化疗。全乳平均剂量为47.6戈伊。评价的所有DVH参数均出现统计学显著性降低，有利于mDIBH的输送而非FB计划。mDIBH计划显著降低了心脏平均剂量（4.23戈伊vs. 2.54戈伊; p<0.001），相对降低了40%。同样，评价的所有其他心脏参数（即，治疗的心脏体积、V30、V25、V20、V15、V10和V5）均显著降低。mDIBH还显著降低了肺剂量，包括左肺平均剂量的降低（9.08戈伊对7.86戈伊; p<0.001），相对降低13%，以及评价的所有肺DVH参数的显著降低。迄今为止，该系列代表了在左侧乳腺癌治疗期间利用mDIBH减少心脏照射的最大经验。与FB计划相比，mDIBH实现了所有心脏和肺DVH参数的统计学显著降低。用于治疗左侧乳腺癌的mDIBH是一种经证实的降低心脏剂量的技术，可降低心脏毒性，并可常规纳入临床。
Moderate Deep Inspiration Breath-hold (mDIBH), utilizing an Active breathing Control (ABC) device has been used in our clinic since 2002 to reduce cardiac dose for patients receiving left-sided breast irradiation. We report our routine use of the mDIBH technique in clinically localized breast cancer, treated to the intact breast, reconstructed breast, or chest wall. Ninety-nine patients with left sided breast cancer were evaluated for ABC treatment, of which, 87 patients were treated with mDIBH. Plans for both the free-breathing (FB) and mDIBH CT scans were evaluated. Dose volume histograms (DVHs) were analyzed for the heart and ipsilateral lung, comparing results for mDIBH vs FB plans. Eighty-seven patients are included for analysis. Of those, 66% received adjuvant chemotherapy with cardiotoxic agents. The mean dose to the whole breast was 47.6 Gy. There was a statistically significant decrease in all DVH parameters evaluated, favoring the delivery of mDIBH over FB plans. mDIBH plans significantly reduced cardiac mean dose (4.23 Gy vs. 2.54 Gy; p<0.001), a relative reduction of 40%. As well, there were significant reductions in all other heart parameters evaluated (i.e volume of heart treated, V30, V25, V20, V15, V10, and V5). mDIBH also significantly reduced lung dose, including a reduction of the left lung mean dose (9.08 Gy vs. 7.86 Gy; p<0.001), a relative reduction of 13%, as well as significant reduction of all lung DVH parameters evaluated. To date, this series represents the largest experience utilizing mDIBH to reduce cardiac irradiation during left-sided breast cancer treatment. Statistically significant reductions in all heart and lung DVH parameters were achieved with mDIBH over FB plans. mDIBH, for the treatment of left sided breast cancer, is a proven technique for reducing cardiac dose that may lead to reduced cardiotoxicity and can be routinely integrated into the clinic.