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Quantitative Assessment of Irradiated Lung Volume and Lung Mass in Breast Cancer Patients Treated with Tangential Fields in Combination with Deep Inspiration Breath Hold (DIBH)

Quantitative Bestimmung von Lungenvolumen und -masse von BrustkrebspatientInnen bei einer Bestrahlung mit tangentialen Feldern unter Einsatz einer Luftanhaltetechnik in tiefer Inspiration (DIBH)

Strahlentherapie und Onkologie volume 186, pages 157–162 (2010)Cite this article

Abstract

Purpose:

Comparison of the amount of irradiated lung tissue volume and mass in patients with breast cancer treated with an optimized tangential-field technique with and without a deep inspiration breath-hold (DIBH) technique and its impact on the normal-tissue complication probability (NTCP).

Material and Methods:

Computed tomography datasets of 60 patients in normal breathing (NB) and subsequently in DIBH were compared. With a Real-Time Position Management Respiratory Gating System (RPM), anteroposterior movement of the chest wall was monitored and a lower and upper threshold were defined. Ipsilateral lung and a restricted tangential region of the lung were delineated and the mean and maximum doses calculated. Irradiated lung tissue mass was computed based on density values. NTCP for lung was calculated using a modified Lyman-Kutcher-Burman (LKB) model.

Results:

Mean dose to the ipsilateral lung in DIBH versus NB was significantly reduced by 15%. Mean lung mass calculation in the restricted area receiving ≤ 20 Gy (M20) was reduced by 17% in DIBH but associated with an increase in volume. NTCP showed an improvement in DIBH of 20%. The correlation of individual breathing amplitude with NTCP proved to be independent.

Conclusion:

The delineation of a restricted area provides the lung mass calculation in patients treated with tangential fields. DIBH reduces ipsilateral lung dose by inflation so that less tissue remains in the irradiated region and its efficiency is supported by a decrease of NTCP.

Zusammenfassung

Ziel:

Vergleichende Bestimmung von bestrahltem Lungenvolumen und bestrahlter Lungenmasse in Normalatmung (NB) und tiefer Inspiration (DIBH) bei PatientInnen mit Brustkrebs, die mit tangentialen Feldern bestrahlt wurden, und ihrem Einfluss auf die Normalgewebskomplikationswahrscheinlichkeit (NTCP).

Material und Methodik:

Computertomographiedatensätze von 60 PatientInnen wurden in NB und DIBH miteinander verglichen. Mit einem „Real-Time Position Management Respiratory Gating System“ (RPM) wurden die anteroposteriore Thoraxbewegung aufgezeichnet und untere und obere Schwellenwerte definiert. Die ipsilaterale Lunge sowie eine beschränkte tangentiale Lungenregion wurden konturiert und die mittlere und maximale Dosis berechnet. Die bestrahlte Lungenmasse wurde mittels Dichteberechnung bestimmt. Die NTCP für die Lunge wurde mit einem modifizierten Lyman-Kutcher-Burman-(LKB-)Modell errechnet.

Ergebnisse:

Die mittlere ipsilaterale Lungendosis war in DIBH gegenüber NB signifikant um 15% reduziert. Die mittlere Lungenmasse (errechnet nach Tabelle 1), die ≤ 20 Gy (M20) erhielt, war in DIBH um 17% reduziert, während das Lungenvolumen deutlich vergrößert war (Tabelle 2). NTCP zeigte in tiefer Inspiration eine Verbesserung von 20% (Abbildung 1). Der Zusammenhang der individuellen Atmungsamplitudenzunahme zwischen NB und DIBH mit dem vergrößerten Lungenvolumen konnte dargestellt werden (Abbildung 2), während keine Korrelation zwischen der individuell erreichten Atmungsamplitude mit der NTCP aufgezeigt werden konnte (Abbildung 3).

Schlussfolgerung:

Die Konturierung eines beschränkten Teils der ipsilateralen Lunge ermöglicht die Bestimmung der bestrahlten Lungenmasse bei Bestrahlung mit tangentialen Feldern. Bei tiefer Inspiration verbleibt ein geringerer Anteil an Lungengewebe im Feld und führt zu einer Reduktion der ipsilateralen Lungendosis, unterstützt durch eine Abnahme der NTCP.

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Affiliations

  1. University Clinic of Therapeutic Radiology and Oncology, Medical University of Graz, Graz, Austria

    Brigitte Zurl PhD, Heidi Stranzl, Peter Winkler & Karin Sigrid Kapp

  2. University Clinic of Therapeutic Radiology and Oncology, Medical University of Graz, Auenbruggerplatz 32, 8036, Graz, Austria

    Brigitte Zurl PhD

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  1. Brigitte Zurl PhD
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  2. Heidi Stranzl
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Correspondence to Brigitte Zurl PhD.

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Zurl, B., Stranzl, H., Winkler, P. et al. Quantitative Assessment of Irradiated Lung Volume and Lung Mass in Breast Cancer Patients Treated with Tangential Fields in Combination with Deep Inspiration Breath Hold (DIBH). Strahlenther Onkol 186, 157–162 (2010). https://doi.org/10.1007/s00066-010-2064-y

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Key Words

  • Breast cancer
  • Lung dose
  • Deep inspiration breath-hold technique
  • NTCP

Schlüsselwörter

  • Brustkrebs
  • Lungendosis
  • Atemtriggerung
  • NTCP