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The UK HeartSpare Study: Randomised evaluation of voluntary deep-inspiratory breath-hold in women undergoing breast radiotherapy

2013; Elsevier BV; Volume: 108; Issue: 2 Linguagem: Inglês

10.1016/j.radonc.2013.04.021

1879-0887

Frederick R. Bartlett, R. Colgan, Karen Carr, Ellen M. Donovan, H. McNair, Imogen Locke, Philip Evans, Joanne Haviland, John Yarnold, Anna M. Kirby,

Lung Cancer Diagnosis and Treatment

Purpose To determine whether voluntary deep-inspiratory breath-hold (v_DIBH) and deep-inspiratory breath-hold with the active breathing coordinator™ (ABC_DIBH) in patients undergoing left breast radiotherapy are comparable in terms of normal-tissue sparing, positional reproducibility and feasibility of delivery. Methods Following surgery for early breast cancer, patients underwent planning-CT scans in v_DIBH and ABC_DIBH. Patients were randomised to receive one technique for fractions 1–7 and the second technique for fractions 8–15 (40 Gy/15 fractions total). Daily electronic portal imaging (EPI) was performed and matched to digitally-reconstructed radiographs. Cone-beam CT (CBCT) images were acquired for 6/15 fractions and matched to planning-CT data. Population systematic (Σ) and random errors (σ) were estimated. Heart, left-anterior-descending coronary artery, and lung doses were calculated. Patient comfort, radiographer satisfaction and scanning/treatment times were recorded. Within-patient comparisons between the two techniques used the paired t-test or Wilcoxon signed-rank test. Results Twenty-three patients were recruited. All completed treatment with both techniques. EPI-derived Σ were ⩽1.8 mm (v_DIBH) and ⩽2.0 mm (ABC_DIBH) and σ ⩽2.5 mm (v_DIBH) and ⩽2.2 mm (ABC_DIBH) (all p non-significant). CBCT-derived Σ were ⩽3.9 mm (v_DIBH) and ⩽4.9 mm (ABC_DIBH) and σ ⩽ 4.1 mm (v_DIBH) and ⩽ 3.8 mm (ABC_DIBH). There was no significant difference between techniques in terms of normal-tissue doses (all p non-significant). Patients and radiographers preferred v_DIBH (p = 0.007, p = 0.03, respectively). Scanning/treatment setup times were shorter for v_DIBH (p = 0.02, p = 0.04, respectively). Conclusions v_DIBH and ABC_DIBH are comparable in terms of positional reproducibility and normal tissue sparing. v_DIBH is preferred by patients and radiographers, takes less time to deliver, and is cheaper than ABC_DIBH.