Effect of continuous positive airway pressure administration during lung stereotactic ablative radiotherapy: a comparative planning study
Effect of continuous positive airway pressure administration during lung stereotactic ablative radiotherapy: a comparative planning study
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DOI：
10.1007/s00066-018-1278-2
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发表时间：
2018-06-01
影响因子：
3.1
通讯作者：
Geets, Xavier
中科院分区：
文献类型：
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作者：
Di Perri, Dario;Colot, Andrea;Geets, Xavier
目的：在立体定向消融放疗（SABR）中，持续气道正压通气（CPAP）可以通过增加肺容量和降低呼吸诱导的肿瘤运动幅度，从而更好地保护肺和心脏。在这项研究中，我们评估了CPAP对肺体积、肿瘤运动幅度和基线位移的影响，以及该策略的剂量学影响。方法20例肺肿瘤SABR患者分别在两个时间点（T0/T1）进行有CPAP和无CPAP的4d计算机断层扫描（CPAP/noCPAP）。首先，比较CPAP和noCPAP扫描的肺体积、肿瘤运动幅度和基线位移。接下来，计算CPAP和noCPAP治疗方案，并比较肺剂量参数（平均肺剂量（MLD）、接受20Gy （V-20Gy）、13Gy （V-13Gy）和5Gy （V-5Gy）的肺体积）和平均心脏剂量（MHD）。结果平均而言，CPAP在T0和T1时分别使肺体积增加8.0% （p < 0.001）和6.3% (p < 0.001)，但未改变肿瘤运动幅度或基线移位。结果CPAP组MLD、肺V-20Gy、V-13Gy、V-5Gy的绝对降幅分别为0.1 gy （p=0.1）、0.4% （p=0.03）、0.5% （p=0.04）、0.5% (p=0.2)，对MHD无显著影响。结论：在肺肿瘤SABR患者中，CPAP增加肺体积，但不改变肿瘤运动或基线移位。因此，CPAP允许肺部辐射剂量的轻微减少，这可能不具有临床意义。
Purpose By increasing lung volume and decreasing respiration-induced tumour motion amplitude, administration of continuous positive airway pressure (CPAP) during stereotactic ablative radiotherapy (SABR) could allow for better sparing of the lungs and heart. In this study, we evaluated the effect of CPAP on lung volume, tumour motion amplitude and baseline shift, as well as the dosimetric impact of the strategy.Methods Twenty patients with lung tumours referred for SABR underwent 4D-computed tomography (CT) scans with and without CPAP (CPAP/noCPAP) at two timepoints (T0/T1). First, CPAP and noCPAP scans were compared for lung volume, tumour motion amplitude, and baseline shift. Next, CPAP and noCPAP treatment plans were computed and compared for lung dose parameters (mean lung dose (MLD), lung volume receiving 20 Gy (V-20Gy), 13 Gy (V-13Gy), and 5 Gy (V-5Gy)) and mean heart dose (MHD).Results On average, CPAP increased lung volume by 8.0% (p < 0.001) and 6.3% (p < 0.001) at T0 and T1, respectively, but did not change tumour motion amplitude or baseline shift. As a result, CPAP administration led to an absolute decrease in MLD, lung V-20Gy, V-13Gy and V-5Gy of 0.1Gy (p=0.1), 0.4% (p=0.03), 0.5% (p=0.04) and 0.5% (p=0.2), respectively, while having no significant influence on MHD.Conclusions In patients referred for SABR for lung tumours, CPAP increased lung volume without modifying tumour motion or baseline shift. As a result, CPAP allowed for a slight decrease in radiation dose to the lungs, which is unlikely to be clinically significant.