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
{"title":"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","authors":"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","doi":"10.1016/j.adro.2024.101651","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><div>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.</div></div><div><h3>Methods and Materials</h3><div>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.</div></div><div><h3>Results</h3><div>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; <em>p</em> = .0389) and ABC (SD difference, 9.9 cGy; <em>p</em> = .0262), but not in SGRT (<em>p</em> = .2272). The CBCT-guided online correction had no impact on the cumulative MHD in all 3 groups.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 12","pages":"Article 101651"},"PeriodicalIF":2.2000,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Prospective Trial on the Impact of Weekly Cone Beam Computed Tomography-Guided Correction on Mean Heart Dose in Breast Cancer Breath-Hold Radiation Therapy\",\"authors\":\"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\",\"doi\":\"10.1016/j.adro.2024.101651\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Purpose</h3><div>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.</div></div><div><h3>Methods and Materials</h3><div>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.</div></div><div><h3>Results</h3><div>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; <em>p</em> = .0389) and ABC (SD difference, 9.9 cGy; <em>p</em> = .0262), but not in SGRT (<em>p</em> = .2272). The CBCT-guided online correction had no impact on the cumulative MHD in all 3 groups.</div></div><div><h3>Conclusions</h3><div>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.</div></div>\",\"PeriodicalId\":7390,\"journal\":{\"name\":\"Advances in Radiation Oncology\",\"volume\":\"9 12\",\"pages\":\"Article 101651\"},\"PeriodicalIF\":2.2000,\"publicationDate\":\"2024-10-10\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Advances in Radiation Oncology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2452109424002148\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Advances in Radiation Oncology","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2452109424002148","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ONCOLOGY","Score":null,"Total":0}
Prospective Trial on the Impact of Weekly Cone Beam Computed Tomography-Guided Correction on Mean Heart Dose in Breast Cancer Breath-Hold Radiation Therapy
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.
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.
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