Evaluation of active breathing control-moderate deep inspiration breath-hold in definitive non-small cell lung cancer radiotherapy

• Published in: Neoplasma Vol. 59; no. 3; p. 333
• Main Authors: Sager, O, Beyzadeoglu, M, Dincoglan, F, Oysul, K, Kahya, Y Elcim, Gamsiz, H, Uysal, B, Demiral, S, Dirican, B, Surenkok, S
• Format: Journal Article
• Language: English
• Published: Slovakia 2012
• Subjects: Adenocarcinoma - diagnostic imaging; Adenocarcinoma - pathology; Adenocarcinoma - radiotherapy; Aged; Breathing Exercises; Carcinoma, Large Cell - diagnostic imaging; Carcinoma, Large Cell - pathology; Carcinoma, Large Cell - radiotherapy; Carcinoma, Non-Small-Cell Lung - diagnostic imaging; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - radiotherapy; Carcinoma, Squamous Cell - diagnostic imaging; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - radiotherapy; Dose Fractionation; Female; Humans; Immobilization; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - pathology; Lung Neoplasms - radiotherapy; Male; Middle Aged; Prognosis; Radiotherapy Planning, Computer-Assisted; Tomography, X-Ray Computed
• ISSN: 0028-2685
• DOI: 10.4149/neo_2012_043

The purpose of this study is to evaluate the effect of Active Breathing Control-moderate deep inspiration breath-hold (ABC-mDIBH) on tumor motion and critical organ doses in non-small cell lung cancer (NSCLC) radiotherapy. 23 patients with locally advanced NSCLC were included in the study. All patients were scanned at free breathing and ABC-mDIBH for radiation treatment planning. 3 separate treatment plans were generated for each patient including one plan with ABC-mDIBH and uniform margins, one plan with free breathing and uniform margins, and one plan with free breathing and 3-dimensional non-uniform margins determined by Cone Beam Computed Tomography (CBCT) and XVI Motion View (X-ray Volume Imaging, Elekta, UK). Critical organ dose-volumes and physical lung parameters were comparatively evaluated on 3 separate dose-volume histograms of each patient acquired from planning software. Individual tumor motion of each patient with and without ABC-mDIBH was documented and compared. Use of ABC-mDIBH resulted in statistically significant improvement in physical lung parameters of V20 (lung volume receiving ≥ 20 Gy) and mean lung dose (MLD) which are predictors of radiation pneumonitis (p<0.001). Reduction in spinal cord dose and tumor motion with ABC-mDIBH was also statistically significant (p<0.001). ABC-mDIBH increases normal lung tissue sparing in definitive NSCLC radiotherapy by improving physical lung parameters along with spinal cord dose reduction through exact tumor immobilization. The incorporation of ABC-mDIBH into NSCLC radiotherapy may have implications for potential margin reduction and dose escalation to improve treatment outcomes.