Abstract
Purpose
In lung cancer, a high radiation dose to the target area correlates with better local control but is frequently counterbalanced by a higher risk of lung toxicity. Several methods exist to coordinate respiratory motion in lung radiotherapy. We aimed to investigate the impact of a breathing-control system on irradiated volumes and dosimetric parameters in three-dimensional conformal radiotherapy (3D-CRT) and stereotactic radiotherapy (SRT) treatments.
Materials and methods
Twelve patients were scheduled for radical radiotherapy: five for SRT and seven for 3D-CRT. For each patient, in addition to the free-breathing computed tomography (CT) scan, four additional sets of CT slices were acquired using the Active Breathing Coordinator device (ABC, Elekta Oncology Systems Ltd., UK).
Results
The volumes acquired with the ABC device were significantly smaller than the free-breathing volumes [23 % reduction of planning tumour volume (PTV), p = 0.002]. ABC allowed a reduction of all dosimetric parameters [2.28 % reduction of percentage volume of lung treated to a dose of ≥20 Gy (V20), p = 0.004; 10 % reduction of mean lung dose (MLD), p = 0.009]. Significant differences were found both in SRT and in 3D-CRT, in peripheral and apical lesions.
Conclusion
In our experience, ABC has the potential to reduce lung toxicity in the treatment of lung cancer; alternatively, it can allow the prescribed dose to be increased while maintaining the same risk of lung toxicity.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Marks LB, Bentzen SM, Deasy JO et al (2010) Radiation-dose volume effect on the lung. Int J Radiat Oncol Biol Phys 76:S70–S76
Rosenzweig KE, Hanley J, Mah D et al (2000) The deep inspiration breath-hold technique in the treatment of inoperable non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 48:81–87
Fenwick JD, Nahum AE, Malik ZI et al (2009) Escalation and intensification of radiotherapy for stage III non-small cell lung cancer: opportunities for treatment improvement. Clin Oncol 21:343–360
Senan S, De Ruysscher D, Giraud P et al (2004) Literature-based recommendations for treatment planning and execution in high-dose radiotherapy for lung cancer. Radiother Oncol 71:139–146
Slotman BJ, Senan S (2011) Radiotherapy in small-cell lung cancer: lessons learned and future directions. Int J Radiat Oncol Biol Phys 79:998–1003
Negoro Y, Nagata Y, Aoki T et al (2001) A new irradiation system for lung cancer combining linear accelerator, computed tomography, patient self-breath-holding, and patient-directed beam-control without respiratory monitoring devices. Int J Radiat Oncol Biol Phys 50:889–898
Graham MV, Purdy JA, Emami B et al (1999) Clinical dose-volume histogram analysis for pneumonitis after 3D treatment for non-small cell lung cancer (NSCLC). Int J Radiat Oncol Biol Phys 45:323–329
Marks LB (2002) Dosimetric predictors of radiation-induced lung injury. Int J Radiat Oncol Biol Phys 54:313–316
Wang S, Liao Z, Wei X et al (2006) Analysis of clinical and dosimetric factors associated with treatment-related pneumonitis (TRP) in patients with non-small-cell lung cancer (NSCLC) treated with concurrent chemotherapy and three-dimensional conformal radiotherapy (3D-CRT). Int J Radiat Oncol Biol Phys 66:1399–1407
Yorke ED, Jackson A, Rosenzweig KE et al (2002) Dose-volume factors contributing to the incidence of radiation pneumonitis in non-small-cell lung cancer patients treated with three-dimensional conformal radiation therapy. Int J Radiat Oncol Biol Phys 54:329–339
Tsujino K, Hirota S, Endo M et al (2003) Predictive value of dose-volume histogram parameters for predicting radiation pneumonitis after concurrent chemoradiation for lung cancer. Int J Radiat Oncol Biol Phys 55:110–116
Panakis N, McNair HA, Christian JA et al (2008) Defining the margins in the radical radiotherapy of non-small cell lung cancer (NSCLC) with active breathing control (ABC) and the effect on physical lung parameters. Radiother Oncol 87:65–73
Ross CS, Hussey DH, Pennington EC et al (1990) Analysis of movement of intrathoracic neoplasms using ultrafast computerized tomography. Int J Radiat Oncol Biol Phys 18:671–677
ICRU (1999) Prescribing, recording and reporting photon beam therapy. Supplement to ICRU Report 50, ICRU Report 62. ICRU, Bethesda, MD, pp 4–52
McNair HA, Brock J, Symonds-Tayler JR et al (2009) Feasibility of the use of the active breathing coordinator (ABC) in patients receiving radical radiotherapy for non-small cell lung cancer (NSCLC). Radiother Oncol 93:424–429
Kirkbride P, Hatton M, Lorigan P et al (2002) Fatal pulmonary fibrosis associated with induction chemotherapy with carboplatin and vinorelbine followed by CHART radiotherapy for locally advanced non-small cell lung cancer. Clin Oncol 14:361–366
Kwa SL, Lebesque JV, Theuws JC et al (1998) Radiation pneumonitis as a function of mean lung dose: an analysis of pooled data of 540 patients. Int J Radiat Oncol Biol Phys 42:1–9
Wong JW, Sharpe MB, Jaffray DA et al (1999) The use of active breathing control (ABC) to reduce margin for breathing motion. Int J Radiat Oncol Biol Phys 44:911–919
Dehing-Oberije C, De Ruysscher D, van Baardwijk A et al (2009) The importance of patient characteristics for the prediction of radiation-induced lung toxicity. Radiother Oncol 91:421–426
Nakayama H, Satoh H, Kurishima K et al (2010) High-dose conformal radiotherapy for patients with stage III non-small-cell lung carcinoma. Int J Radiat Oncol Biol Phys 78:645–650
Shen Y, Zhang H, Wang J et al (2010) Hypofractionated radiotherapy for lung tumors with online cone beam CT guidance and active breathing control. Radiat Oncol 5:19
Vogelius IS, Westerly DC, Cannon GM et al (2010) Hypofractionation does not increase radiation pneumonitis risk with modern conformal radiation delivery techniques. Acta Oncol 49:1052–1057
Brock J, McNair HA, Panakis N et al (2011) The use of the active breathing coordinator throughout radical non-small-cell lung cancer (NSCLC) radiotherapy. Int J Radiat Oncol Biol Phys 81:369–375
Wang J, Zhong R, Bai S et al (2010) Evaluation of positioning accuracy of four different immobilizations using cone-beam CT in radiotherapy of non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 77:1274–1281
Shirato H, Suzuki K, Sharp GC et al (2000) Speed and amplitude of lung tumor motion precisely detected in four-dimensional setup and in real-time tumor-tracking radiotherapy. Int J Radiat Oncol Biol Phys 64:1229–1236
Conflict of interest
V. Scotti, L. Marrazzo, C. Saieva, B. Agresti, I. Meattini, I. Desideri, S. Cecchini, S. Bertocci, C. Franzese, C. De Luca Cardillo, G. Zei, M. Loi, D. Greto, M. Mangoni, P. Bonomo, L. Livi, G. Biti declare no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Scotti, V., Marrazzo, L., Saieva, C. et al. Impact of a breathing-control system on target margins and normal-tissue sparing in the treatment of lung cancer: experience at the radiotherapy unit of Florence University. Radiol med 119, 13–19 (2014). https://doi.org/10.1007/s11547-013-0307-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11547-013-0307-6