The Use of the Active Breathing Coordinator Throughout Radical Non–Small-Cell Lung Cancer (NSCLC) Radiotherapy

Brock, Juliet; McNair, Helen; Panakis, N.; Symonds‐Tayler, Richard; Evans, Philip; Brada, Michael

doi:10.1016/j.ijrobp.2010.05.038

Cited by 47 publications

(50 citation statements)

References 31 publications

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“…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).…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

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confidence: 99%

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

et al. 2016

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The phase III dose escalation trial RTOG 0617 [4] showed that heart dose parameters were correlated to death in a multivariate analysis and in a dose escalation trial by Cannon et al.[5] serious late toxicity from central and perihilar structures was encountered. In breast cancer radiotherapy a large population-based case-control study showed an increased risk of major cardiac events with increasing heart dose [6]. 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.We previously reported preliminary results from the first 10 patients included in this study and found a statistically significant reduction of mean lung dose with DIBH 3D-CRT as well as with VMAT in patients with locally advanced NSCLC [12]. The combination of DIBH and VMAT reduced these parameters further and DIBH mitigated the low dose bath induced by VMAT.Most previous studies have focused on dose to the lungs and none of them have reported on dose to bronchi and trachea. In this final report, we examine if DIBH-VMAT holds potential to decrease doses to mediastinal organs at risk (OAR) compared to free breathing (FB) VMAT. Material and methodsSeventeen patients with locally advanced NSCLC were included prospectively from April 2012 to September 2013. Inclusion criteria were ability to perform a voluntary breathhold for 20 seconds and to follow the audio-visual coaching instructions. All patients were treated in FB. The delineations and treatment planning was performed retrospectively.The study was approved by the local ethical committee (H-2-2011-153). Patient characteristics are listed in Supplementary Table 1S (available online at http://www.informahealthcare. com).The patients were audio visually coached to hold their breath at a comfortable level of deep inspiration for 20 seconds at a time during a 15-minute session. The Realtime Position Management TM system (VarianV R Medical Systems) was used to track and record the respiratory signal. The planning procedure included a FB positron emission tomography (PET)/computed tomography (CT) (with 18-Fluorodeoxyglucose tracer), a respiration correlated CT (4D-CT) and three consecutive audio-visual coached DIBH-CT scans (for registration of intra-fraction variation). The mid-ventilation phase (MidV) [13] of the 4D-CT was selected for the FB plan and the first acquired DIBH-CT for the DIBH plan.To minimize observer variations, the gross tumor volume (GTV) delineations were performed after a strict protocol, with the same radiologist contouring on both the MidV and the DIBH-CT fo...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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

et al. 2016

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“…Patients were scanned and treated using the active breathing coordinator [12] device and were also imaged using cone-beam CT (CBCT) for the first three fractions and then weekly thereafter. In this study, five clinical patient plans were reviewed.…”

Section: Methodsmentioning

confidence: 99%

“…The availability of CBCT online correction makes this an unlikely clinical scenario but the method is sufficient to simulate the effect of internal structure movement that is less easily corrected for [12]. Each clinical plan was then applied to the shifted isocentres by fixing the monitor units and recalculating.…”

Section: Methodsmentioning

confidence: 99%

Assessment of the robustness of volumetric-modulated arc therapy for lung radiotherapy

Edmunds

Bedford²

2013

The British Journal of Radiology

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Volumetric-modulated arc therapy (VMAT) is increasingly popular as a treatment method in radiotherapy owing to the speed with which treatments can be delivered. However, there has been little investigation into the effect of increased modulation in lung plans with regard to interfraction organ motion. This is most likely to occur where the planning target volume (PTV) lies within areas of low density. This paper aims to investigate the effect of modulation on the dose distribution using simulated patient movement and to propose a method that is less susceptible to such movement. Simulated interfraction motion is achieved by moving the plan isocentre in steps of 0.5 cm and 1.0 cm in six directions for five clinical VMAT patients. The proposed planning method involves optimisation using a density override of 1 g cm 23 , within the PTV in lung, to reduce segment boosting in the periphery of the PTV. This investigation shows that modulation can result in an increase in the maximum dose of .25%, an increase in PTV near-maximum dose of 17% and a reduction in near-minimum dose by 46%. Unacceptable organ at risk (OAR) doses are also seen. The proposed method reduces modulation, resulting in a maximum dose increase of 10%. Although safeguards are in place to prevent the increased dose to OARs from patient movement, there is nothing to prevent the increased dose as a result of modulation in lung. A simple planning method is proposed to safeguard against this effect. Investigation suggests that, where modulation exists in a plan, this method reduces it and is clinically viable.

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“…To this end, continuous efforts are aimed at minimizing the dose delivered to organs at risk while maintaining or even maximizing the dose to the target. Recent but widely implemented techniques contributing greatly to conformal dose distribution, particularly in the thorax, include image guidance (IGRT), e.g., using kV imaging and cone beam computed tomography to reduce set-up errors [8,40], techniques which meet concerns of moving targets, e.g., breath-hold techniques [46,79], and gating [55] and intensity-modulated photon radiotherapy (IMRT) [29]. IMRT can improve conformality compared with conformal 3D techniques, especially in cases of geometrically complex targets.…”

Section: Current and Future Strategies Of Radiation Oncology To Reducmentioning

confidence: 99%

Cardiac side effects of conventional and particle radiotherapy in cancer patients

Wittig

Engenhart‐Cabillic

2011

Herz

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The Use of the Active Breathing Coordinator Throughout Radical Non–Small-Cell Lung Cancer (NSCLC) Radiotherapy

Cited by 47 publications

References 31 publications

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

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

Assessment of the robustness of volumetric-modulated arc therapy for lung radiotherapy

Cardiac side effects of conventional and particle radiotherapy in cancer patients

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