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Dosimetric comparison of free-breathing and deep inspiration breath-hold radiotherapy for lung cancer

Dosimetrischer Vergleich einer Strahlentherapie bei Lungenkrebs unter freier Atmung und angehaltener Atmung nach tiefer Einatmung

Abstract

Purpose

The goal of this work was to evaluate the potential benefit of deep inspiration breath-hold (DIBH) compared to free breathing (FB) radiotherapy in a homogeneous population of patients with lung cancer.

Methods and materials

A total of 25 patients with non-small cell lung cancer treated by DIBH underwent an additional FB CT scan. The DIBH and FB treatment plans were compared. Target volume was compared using coverage, homogeneity, and conformal indices. Organs at risk were compared using V5, V13, V20, V25, V37, mean dose (Dmean) for lungs, V40 and Dmean for the heart, V50, Dmean and maximum dose (Dmax) for the esophagus, and using biological indices, i.e., the equivalent uniform dose (EUD) and the normal tissue complication probability (NTCP).

Results

Median age was 62 years. Prescribed total dose was 66 Gy. Conformity index was improved with DIBH (0.67 vs. 0.58, p = 0.046) but coverage and homogeneity indices were not significantly different. Lung dosimetric parameters were improved using DIBH: Dmean (13 vs. 15 Gy, p = 10-4), V5 (43 vs. 51%, p = 6.10-5), V13 (31 vs. 38%, p = 2.10-3), V20 (25 vs. 31%, p = 0.01), V25 (22% vs. 27%, p = 0.01) and V37 (12 vs. 16%, p = 0.03), EUD (8.2 vs. 9.9 Gy, p = 3.10-4), and NTCP (1.9 vs. 4.8%, p = 10-3). For the heart, Dmean (14 vs. 17 Gy, p = 0.003), V40 (12 vs. 17%, p = 0.004), and EUD (19 vs. 22 Gy, p = 6.10-4) were reduced with DIBH, whereas V30 and NTCP were similar. DIBH improved the Dmean (28 vs. 30 Gy, p = 0.007) and V50 (25 vs. 30%, p = 0.003) for the esophagus, while EUD, NTCP, and Dmax were not altered.

Conclusion

DIBH improves the target conformity index and heart and lung dosimetry in lung cancer patients treated with radiotherapy. The clinical implications of these findings should be confirmed.

Zusammenfassung

Ziel

Ziel dieser Studie war die Evaluation des potentiellen Vorteils vom Anhalten der Atmung nach tiefer Einatmung („deep inspiration breath-hold“, DIBH) im Vergleich zur freien Atmung („free breathing“, FB) bei der Strahlentherapie in einer homogenen Population von Lungenkrebspatienten.

Methodik und Material

Insgesamt 25 Patienten mit nicht-kleinzelligem Bronchuskarzinom, die mit DIBH behandelt wurden, wurden zusätzlich mittels Computertomografie während freier Atmung untersucht. Nach Erstellen der Dosis-Volumen-Histogramme wurde der Behandlungsplan für DIBH und FB verglichen. Der Vergleich der beiden Techniken wurde aufgrund des Lungenzielvolumens mit folgenden Indizes gemacht: Abdeckung, Homogenität und Konformität. Die kritischen Organe wurden anhand der Parameter V5, V13, V20, V25, V37, durchschnittliche Dosis (Dmittel) für die Lunge, V40 und Dmittel für das Herz, V50, Dmittel und maximale Dosis (Dmax) für den Oesophagus sowie anhand der biologischen Indizes, dem EUD-Konzept („equivalent uniform dose“) und der Wahrscheinlichkeit von normalen Gewebekomplikationen („normal tissue complication probability“, NTCP), verglichen.

Ergebnisse

Das mediane Alter ergab 62 Jahre. Die vorgeschriebene totale Dosis betrug 66 Gy. Bei der Behandlung mit DIBH war der Konformitätsindex signifikant verbessert (0,67 vs. 0,58; p = 0,046), wogegen bei den Indizes der Abdeckung und Homogenität keine signifikanten Unterschiede zu beobachten waren. Bei den kritischen Organen waren die dosimetrischen Lungenparameter verbessert: Dmittel (13 Gy vs. 15 Gy; p = 10-4), V5 (43% vs. 51%; p = 6,10-5), V13 (31% vs. 38%; p = 2,10-3), V20 (25% vs. 31%; p = 0,01), V25 (22% vs. 27%; p = 0,01) und V37 (12% vs. 16%; p = 0,03) sowie der EUD (8,2 Gy vs. 9,9 Gy; p = 3,10-4) und NTCP (1,9% vs. 4,8%; p = 10-3). Im Herz waren bei Behandlung mit DIBH Dmittel (14 Gy vs. 17 Gy; p = 0,003), V40 (12% vs. 17%; p = 0,004) und EUD (19 Gy vs. 22 Gy; p = 6,10-4) reduziert, V30 und NTCP waren vergleichbar zwischen beiden Techniken. Im Oesophagus waren bei der Behandlung mit DIBH Dmittel (28 Gy vs. 30 Gy; p = 0,007) und V50 (25% vs. 30%; p = 0,003) verbessert, während EUD, NTCP und Dmax unverändert blieben.

Schlussfolgerung

Die Strahlentherapie mit DIBH verbessert bei Lungenkrebspatienten den Konformitätsindex sowie die Dosimetrie in Herz und Lunge. Die klinische Auswirkung dieser Ergebnisse muss noch bestätigt werden.

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Marchand, V., Zefkili, S., Desrousseaux, J. et al. Dosimetric comparison of free-breathing and deep inspiration breath-hold radiotherapy for lung cancer. Strahlenther Onkol 188, 582–591 (2012). https://doi.org/10.1007/s00066-012-0129-9

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  • DOI: https://doi.org/10.1007/s00066-012-0129-9

Keywords

  • Radiation dosage
  • Dosimetric comparison
  • Respiration
  • Breathing

Schlüsselwörter

  • Strahlendosis
  • Dosimetrischer Vergleich
  • Respiration
  • Atmung