Evaluation of active breathing control-moderate deep inspiration breath-hold in definitive non-small cell lung cancer radiotherapy

Abstract

The purpose of this study is to evaluate the effect of Active Breathing Control-moderate deep inspiration breath-hold (ABC-mDIBH) on tumor motion and critical organ doses in non-small cell lung cancer (NSCLC) radiotherapy. 23 patients with locally advanced NSCLC were included in the study. All patients were scanned at free breathing and ABC-mDIBH for radiation treatment planning. 3 separate treatment plans were generated for each patient including one plan with ABC-mDIBH and uniform margins, one plan with free breathing and uniform margins, and one plan with free breathing and 3-dimensional non-uniform margins determined by Cone Beam Computed Tomography (CBCT) and XVI Motion View (X-ray Volume Imaging, Elekta, UK). Critical organ dose-volumes and physical lung parameters were comparatively evaluated on 3 separate dose-volume histograms of each patient acquired from planning software. Individual tumor motion of each patient with and without ABC-mDIBH was documented and compared. Use of ABC-mDIBH resulted in statistically significant improvement in physical lung parameters of V20 (lung volume receiving ≥ 20 Gy) and mean lung dose (MLD) which are predictors of radiation pneumonitis (p<0.001). Reduction in spinal cord dose and tumor motion with ABC-mDIBH was also statistically significant (p<0.001). ABC-mDIBH increases normal lung tissue sparing in definitive NSCLC radiotherapy by improving physical lung parameters along with spinal cord dose reduction through exact tumor immobilization. The incorporation of ABC-mDIBH into NSCLC radiotherapy may have implications for potential margin reduction and dose escalation to improve treatment outcomes.

Deep inspiration breath-hold volumetric modulated arc radiotherapy decreases dose to mediastinal structures in locally advanced lung cancer

“…Earlier studies on DIBH in lung cancer RT reported a 15-30% decrease in lung dose parameters, approximately 15% reduction in heart dose parameters and 10% decrease in esophagus dose parameters [7][8][9][17][18][19]. Marchand et al [8] found a significant reduction with DIBH compared to FB in both heart MD (from 16.7 to 13.6 Gy) and esophagus MD (from 30.1 to 27.9 Gy).…”

“…During deep inspiration breath-hold (DIBH), the lungs are inflated and the heart displaced caudally and these anatomical changes can be exploited to achieve a lower radiation dose to the intra-thoracic normal tissue. Several reports have shown that DIBH radiotherapy (RT) is a feasible alternative and has the potential of decreasing the lung dose in conventional three-dimensional conformal radiotherapy (3D-CRT) [7][8][9] and also with volumetric modulated arc therapy (VMAT) [10]. Furthermore, DIBH RT does not acquire a lot of time [11] or economical resources for implementation.…”

Assessment of Target Volume Definition for Radiosurgery of Atypical Meningiomas with Multimodality Imaging

“…Arc Modulation Optimization Algorithm (AMOA) has been utilized for optimization of target volume coverage and critical organ sparing. SBRT [38][39][40][41][42][43][44] .…”

Breast Cancer Adjuvant Radiotherapy Using Active Breathing Control-Moderate Inspiration Breath-Hold – a Case Report

“…Jednou z možností, jak čás tečně vyřešit tento problém, je ABC (active breathing control), která využívá jednoduchého přístroje k omezení dý chacích pohybů hrudníku. Tento postup byl ověřen na nádorech plic [10][11][12], prsu [13][14][15], jater [16], Hodgkinově chorobě [17]…”