Prospective Trial on the Impact of Weekly Cone Beam Computed Tomography-Guided Correction on Mean Heart Dose in Breast Cancer Breath-Hold Radiation Therapy

IF 2.2 Q3 ONCOLOGY Advances in Radiation Oncology Pub Date : 2024-10-10 DOI:10.1016/j.adro.2024.101651

Adrian Wai Chan MBBS , Anh Hoang BSc , Hanbo Chen MD , Merrylee McGuffin MSc , Danny Vesprini MD , Liying Zhang PhD , Matt Wronski PhD , Irene Karam MD

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Abstract

Purpose

Surface guided radiation therapy (SGRT) in breast cancer radiation therapy (RT) may decrease the need for image guidance such as cone beam computed tomography (CBCT). The goal of this study was to evaluate the impact of CBCT image guidance on the cumulative and interfractional variation of mean heart dose (MHD) during breath-hold RT in patients with breast cancer. We hypothesized that weekly CBCT is not necessary for SGRT-assisted breath-hold but is still needed in patients treated with voluntary deep inspiration breath-hold (vDIBH) and active breathing control (ABC) to maintain a stable MHD.

Methods and Materials

This was a prospective, single-center trial that sequentially assigned breast cancer patients to adjuvant RT 40 to 50 Gy in 15 to 25 fractions using vDIBH, ABC, or SGRT to reproduce the breath-hold. The MHD was estimated on each of the weekly CBCT images before and after online correction. The cumulative and interfractional variation of MHD, which were represented by the average and SD of MHD in each patient, were compared in the series of CBCT before and after online correction to evaluate whether online CBCT-guided correction could lead to a more reproducible MHD.

Results

Fifty-five patients were included (vDIBH = 16, ABC = 19, and SGRT = 20). The CBCT-guided online correction was associated with a significant decrease in the interfractional variation of MHD in vDIBH (SD difference, 22.6 cGy; p = .0389) and ABC (SD difference, 9.9 cGy; p = .0262), but not in SGRT (p = .2272). The CBCT-guided online correction had no impact on the cumulative MHD in all 3 groups.

Conclusions

This study demonstrated that CBCT-guided online correction could reduce the interfractional variation of MHD in ABC or vDIBH. When SGRT was available, CBCT-guided correction had no impact on the stability of MHD across the treatment fractions. Future studies may explore whether the CBCT frequency could be reduced to less than weekly in SGRT to decrease treatment time and the radiation dose associated with CBCT.

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每周锥形束计算机断层扫描引导校正对乳腺癌屏气放射治疗中平均心脏剂量影响的前瞻性试验

目的乳腺癌放射治疗（RT）中的表面引导放射治疗（SGRT）可减少对锥形束计算机断层扫描（CBCT）等图像引导的需求。本研究的目的是评估 CBCT 图像引导对乳腺癌患者屏气 RT 期间平均心脏剂量（MHD）的累积和点间变化的影响。我们假设，SGRT 辅助屏气治疗不需要每周 CBCT，但采用自主深吸气屏气（vDIBH）和主动呼吸控制（ABC）治疗的患者仍需要每周 CBCT，以维持稳定的 MHD。在线校正前后，对每周 CBCT 图像的 MHD 进行了估算。在线校正前后的一系列 CBCT 图像比较了 MHD 的累积和分数间变化（以每位患者 MHD 的平均值和 SD 表示），以评估 CBCT 指导下的在线校正是否能使 MHD 更具有可重复性。CBCT 引导下的在线校正显著降低了 vDIBH 和 ABC 患者的 MHD 间变异（SD 差异为 22.6 cGy；p = .0389），但 SGRT 患者的 MHD 间变异没有显著降低（p = .2272）。结论这项研究表明，CBCT 引导的在线校正可以减少 ABC 或 vDIBH 中 MHD 的点阵间差异。在可以使用 SGRT 的情况下，CBCT 引导下的校正对各治疗分段间 MHD 的稳定性没有影响。未来的研究可能会探讨在 SGRT 中是否可以将 CBCT 频率降至每周一次以下，以减少治疗时间和 CBCT 相关的辐射剂量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Advances in Radiation Oncology Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

4.60

自引率

4.30%

发文量

208

审稿时长

98 days

期刊介绍： The purpose of Advances is to provide information for clinicians who use radiation therapy by publishing: Clinical trial reports and reanalyses. Basic science original reports. Manuscripts examining health services research, comparative and cost effectiveness research, and systematic reviews. Case reports documenting unusual problems and solutions. High quality multi and single institutional series, as well as other novel retrospective hypothesis generating series. Timely critical reviews on important topics in radiation oncology, such as side effects. Articles reporting the natural history of disease and patterns of failure, particularly as they relate to treatment volume delineation. Articles on safety and quality in radiation therapy. Essays on clinical experience. Articles on practice transformation in radiation oncology, in particular: Aspects of health policy that may impact the future practice of radiation oncology. How information technology, such as data analytics and systems innovations, will change radiation oncology practice. Articles on imaging as they relate to radiation therapy treatment.