Key result
Surface-guided deep inspiration breath-hold radiotherapy demonstrated high intra-breath-hold stability with a median standard deviation of 0.3 mm and inter-fraction reproducibility of 1.3 mm.
Why the study?
Patients with left-sided breast cancer frequently receive deep inspiration breath-hold radiotherapy to reduce cardiac side effects, but intra-breath-hold stability and inter-fraction reproducibility needed evaluation in clinical practice.
Observational (n=103)
No
Surface-guided deep inspiration breath-hold with automated gating and visual feedback provides highly stable and reproducible positioning for left-sided breast cancer radiotherapy, which is critical for minimizing cardiac radiation dose.
PURPOSE: Patients with left-sided breast cancer frequently receive deep inspiration breath-hold (DIBH) radiotherapy to reduce the risk of cardiac side effects. The aim of the present study was to analyze intra-breath-hold stability and inter-fraction breath-hold reproducibility in clinical practice. MATERIAL AND METHODS: Overall, we analyzed 103 patients receiving left-sided breast cancer radiotherapy using a surface-guided DIBH technique. During each treatment session the vertical motion of the patient was continuously measured by a surface guided radiation therapy (SGRT) system and automated gating control (beam on/off) was performed using an audio-visual patient feedback system. Dose delivery was automatically triggered when the tracking point was within a predefined gating window. Intra-breath-hold stability and inter-fraction reproducibility across all fractions of the entire treatment course were analyzed per patient. RESULTS: In the present series, 6013 breath-holds during beam-on time were analyzed. The mean amplitude of the gating window from the baseline breathing curve (maximum expiration during free breathing) was 15.8 mm (95%-confidence interval: [8.5-30.6] mm) and had a width of 3.5 mm (95%-CI: [2-4.3] mm). As a measure of intra-breath-hold stability, the median standard deviation of the breath-hold level during DIBH was 0.3 mm (95%-CI: [0.1-0.9] mm). Similarly, the median absolute intra-breath-hold linear amplitude deviation was 0.4 mm (95%-CI: [0.01-2.1] mm). Reproducibility testing showed good inter-fractional reliability, as the maximum difference in the breathing amplitudes in all patients and all fractions were 1.3 mm on average (95%-CI: [0.5-2.6] mm). CONCLUSION: The clinical integration of an optical surface scanner enables a stable and reliable DIBH treatment delivery during SGRT for left-sided breast cancer in clinical routine.
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Reitz et al. (2020) conducted an observational in Left-sided breast cancer (n=103). Surface-guided deep inspiration breath-hold (DIBH) radiotherapy was evaluated on Intra-breath-hold stability (median standard deviation of the breath-hold level) (95% CI 0.1-0.9). Surface-guided deep inspiration breath-hold radiotherapy demonstrated high intra-breath-hold stability with a median standard deviation of 0.3 mm and inter-fraction reproducibility of 1.3 mm.
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