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Elshof J, Steenstra C, Niezink A, Wijkstra P, Wijsman R, Duiverman M. Continuous and bilevel positive airway pressure may improve radiotherapy delivery in patients with intra-thoracic tumors. Clin Transl Radiat Oncol 2024; 47:100784. [PMID: 38706725 PMCID: PMC11063599 DOI: 10.1016/j.ctro.2024.100784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 04/11/2024] [Accepted: 04/20/2024] [Indexed: 05/07/2024] Open
Abstract
Background Minimizing tumor motion in radiotherapy for intra-thoracic tumors reduces side-effects by limiting radiation exposure to healthy tissue. Continuous or Bilevel Positive Airway Pressure (CPAP/BiPAP) could achieve this, since it could increase lung inflation and decrease tidal volume variability. We aim to identify the better CPAP/BiPAP setting for minimizing tumor motion. Methods In 10 patients (5 with lung cancer, 5 with other intra-thoracic tumors), CPAP/BiPAP was tested with the following settings for 10 min each: CPAP 5, 10 and 15 cmH2O and BiPAP 14/10 cmH2O with a lower (7 breaths/min) and higher back-up respiratory rate (BURR initially 1 breath/min above the spontaneous breathing frequency, with the option to adjust if the patient continued to initiate breaths). Electrical impedance tomography was used to analyse end-expiratory lung impedance (EELI) as an estimate of end-expiratory lung volume and tidal impedance variation (TIV) as an estimate of tidal volume. Results Nine out of ten patients tolerated all settings; one patient could not sustain CPAP-15. A significant difference in EELI was observed between settings (χ2 22.960, p < 0.001), with most increase during CPAP-15 (median (IQR) 1.03 (1.00 - 1.06), normalized to the EELI during spontaneous breathing). No significant differences in TIV and breathing variability were found between settings. Conclusions This study shows that the application of different settings of CPAP/BiPAP in patients with intra-thoracic tumors is feasible and tolerable. BiPAP with a higher BURR may offer the greatest potential for mitigating tumor motion among the applied settings, although further research investigating tumor motion should be conducted.
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Affiliation(s)
- J. Elshof
- Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Groningen Research Institute for Asthma and COPD, University of Groningen, Groningen, The Netherlands
| | - C.M. Steenstra
- Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Groningen Research Institute for Asthma and COPD, University of Groningen, Groningen, The Netherlands
| | - A.G.H. Niezink
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - P.J. Wijkstra
- Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Groningen Research Institute for Asthma and COPD, University of Groningen, Groningen, The Netherlands
| | - R. Wijsman
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M.L. Duiverman
- Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Groningen Research Institute for Asthma and COPD, University of Groningen, Groningen, The Netherlands
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Choi MS, Park RH, Lee J, Cho Y, Chang JS, Kim J, Kim JS. Dosimetric Comparison of CPAP and DIBH for Left-sided Breast Cancer Radiation Therapy. Adv Radiat Oncol 2024; 9:101478. [PMID: 38681894 PMCID: PMC11043855 DOI: 10.1016/j.adro.2024.101478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/10/2024] [Indexed: 05/01/2024] Open
Abstract
Purpose Despite the increasing interest in using continuous positive airway pressure (CPAP) in radiation therapy (RT), direct comparisons with the more widely used deep inspiration breath-hold (DIBH) have been limited. This planning study aimed to offer comprehensive geometric and dosimetric evidence by comparing CPAP and DIBH-based RT plans. Materials and Methods A retrospective data set of 35 patients with left-sided breast cancer with planning computed tomography scans under three breathing conditions (free breathing (FB), CPAP with 10 cmH2O pressure, and DIBH) was collected. Volumetric arc therapy plans aimed for 95% dose coverage to 95% of the planning target volume with a maximum dose below 107%. A comparative dosimetric analysis among the three plans was conducted. Additionally, geometric differences were assessed by calculating the minimum distance between the heart and the clinical target volume (CTV) in each planning computed tomography. Results CPAP and DIBH plans demonstrated comparable mean heart doses (1.05 Gy), which were significantly lower than the FB plan (1.34 Gy). The maximum dose to the left anterior descending artery was smallest in the CPAP plan (4.44 Gy), followed by DIBH (4.73 Gy) and FB (7.33 Gy) plans. Other organ-at-risk doses for CPAP and DIBH were similar, with mean contralateral breast doses of 2.27 and 2.21 Gy, mean ipsilateral lung doses of 4.09 and 4.08 Gy, V20 at 6.11% and 6.31%, and mean contralateral lung doses of 0.94 and 0.92 Gy, respectively. No significant difference was found in the minimum heart-to-CTV distance between CPAP and DIBH. DIBH exhibited the greatest lung volume (3908 cc), followed by CPAP (3509 cc), and FB(2703 cc). Conclusions The comparison between CPAP and DIBH shows their similarity in both geometric and dosimetric aspects, providing strong evidence for CPAP's effectiveness and feasibility in RT. This suggests its potential as an alternative to DIBH for patients with left-sided breast cancer.
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Affiliation(s)
- Min Seo Choi
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, South Korea
- Medical Physics and Biomedical Engineering Laboratory (MPBEL), Yonsei University College of Medicine, Seoul, South Korea
| | - Ryeong Hwang Park
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Joongyo Lee
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Radiation Oncology, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Yeona Cho
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jee Suk Chang
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Jihun Kim
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Sung Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, South Korea
- Medical Physics and Biomedical Engineering Laboratory (MPBEL), Yonsei University College of Medicine, Seoul, South Korea
- Oncosoft Inc, Seoul, South Korea
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Appel S, Lawrence YR, Bar J, Jacobson G, Marom EM, Katzman T, Ben-Ayun M, Dubinski S, Haisraely O, Weizman N, Davidson T, Weiss I, Mansano A, Goldstein JD, Symon Z. Deep inspiratory breath hold assisted by continuous positive airway pressure ventilation for lung stereotactic body radiotherapy. Cancer Radiother 2023; 27:23-30. [PMID: 36057519 DOI: 10.1016/j.canrad.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/14/2022] [Accepted: 05/24/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE Continuous positive airway pressure (CPAP) ventilation hyperinflates the lungs and reduces diaphragmatic motion. We hypothesized that CPAP could be safely combined with deep inspiratory breath hold (CPAP-DIBH) during lung stereotactic radiotherapy (SBRT). MATERIAL AND METHODS Patients with stage-1 lung cancer or lung metastasis treated with CPAP-DIBH SBRT between 3/2017-5/2021 were analyzed retrospectively. Patient characteristics, treatment parameters, duration of breath holds in all sessions and tolerance to CPAP-DIBH were recorded. Local control (LC) was assessed from CT or PET-CT imaging. The distances between the tumor and mediastinal organs at risk (OAR) in centrally located tumors using either free breathing (FB) or CPAP-DIBH were compared. Toxicity was graded retrospectively. RESULTS Forty-five patients with 71 lesions were treated with CPAP-DIBH SBRT. Indications for CPAP-DIBH were prior radiation (35/71, 65%), lower lobe location (34/71, 48%), multiple lesions (26/71, 36.6%) and proximity to mediastinal OAR (7/71, 10%). Patient characteristics were: F:M 43%: 57%; mean gross tumor volume 4.5cm3 (SD 7.9), mean planning target volume 20cm3 (SD 27), primary: metastatic lesions (7%:93%). Mean radiation dose was 52.5 Gray (SD3.5). Mean lung volume was 5292cm3 (SD 1106). Mean duration of CPAP-DIBH was 41.3s (IQR 31-46.8). LC at 2 years was 89.5% (95% CI 76-95.5). In patients with central lesions, the distance between the tumor and mediastinal OAR increased from 0.84cm (SD 0.65) with FB to 1.23cm (SD 0.8) with CPAP-DIBH (p=0.002). Most patients tolerated CPAP well and completed all treatments after starting therapy. Three patients did not receive treatment: 2 were unable to tolerate CPAP and 1 had syncope (pre-existing). Toxicity was grade 2 in 4/65 (6%) and grade 3 in 1/65 (1.5%). There was no grade 2 or higher esophageal or tracheal toxicities. CONCLUSION CPAP-DIBH assisted lung SBRT was tolerated well and was associated with minimal toxicity and favorable LC. This technique may be considered when treating multiple lung lesions, lesions located in the lower lobes or adjacent to mediastinal OAR.
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Affiliation(s)
- Sarit Appel
- Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yaacov Richard Lawrence
- Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jair Bar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Institute of Oncology, Sheba Medical Center, Tel Hashomer, Israel
| | - Galia Jacobson
- Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Edith M Marom
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Radiology, Sheba Medical Center, Tel Hashomer, Israel
| | - Tamar Katzman
- Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maoz Ben-Ayun
- Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sergei Dubinski
- Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ory Haisraely
- Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noam Weizman
- Department of Radiation Oncology, Hadassah Medical Center, Jerusalem, Israel
| | - Tima Davidson
- Nuclear Medicine, Sheba Medical Center, Tel Hashomer, Israel
| | - Ilana Weiss
- Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Mansano
- Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Zvi Symon
- Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Zhang Y, Li X, Zhang Y, Ye Y, Jen YM, Pan X, Li X, Qin T, Li P, Lv C, Qi Y, Wang X, Yang Y, Ma T. Non-invasive high frequency oscillatory ventilation inhibiting respiratory motion in healthy volunteers. Sci Rep 2022; 12:22604. [PMID: 36585458 PMCID: PMC9803652 DOI: 10.1038/s41598-022-27288-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 12/29/2022] [Indexed: 12/31/2022] Open
Abstract
Precision radiotherapy needs to manage organ movements to prevent critical organ injury. The purpose of this study is to examine the feasibility of motion control of the lung by suppressing respiratory motion. The non-invasive high frequency oscillatory ventilation (NIHFOV) is a technique commonly used in the protection of lung for patients with acute lung disease. By using a very high respiratory frequency and a low tidal volume, NIHFOV allows gas exchange, maintains a constant mean airway pressure and minimizes the respiratory movements. We tested healthy volunteers NIHFOV to explore the optimal operational parameter setting and the best possible motion suppression achievable. This study was conducted with the approval of Institutional Review Boards of the Wuwei Cancer hospital (approval number: 2021-39) and carried out in accordance with Declaration of Helsinki. The study comprises two parts. Twenty three healthy volunteers participated in the first part of the study. They had 7 sessions of training with the NIHFOV. The duration of uninterrupted, continuous breathing under the NIHFOV and the optimal operational machine settings were defined. Eight healthy volunteers took part in the second part of the study and underwent 4-dimensional CT (4DCT) scanning with and without NIHFOV. Their respiratory waveform under free breathing (FB) and NIHFOV were recorded. The maximum range of motion of the diaphragm from the two scannings was compared, and the variation of bilateral lung volume was obtained to evaluate the impact of NIHFOV technique on lung volume. The following data were collected: comfort score, transcutaneous partial pressure of oxygen (PtcO2), transcutaneous partial pressure of carbon dioxide (PtcCO2), and pulse rate. Data with and without NIHFOV were compared to evaluate its safety, physiological impacts and effect of lung movement suppression. All the volunteers completed the training sessions eventlessly, demonstrating a good tolerability of the procedure. The median NIHFOV-on time was 32 min (22-45 min), and the maximum range of motion in the cephalic-caudal direction was significantly reduced on NIHFOV compared with FB (1.8 ± 0.8 cm vs 0.3 ± 0.1 cm, t = - 3.650, P = 0.003); the median range of motion was only 0.3 ± 0.1 cm on NIHFOV with a good reproducibility. The variation coefficient under NIHFOV of the right lung volume was 2.4% and the left lung volume was 9.2%. The PtcO2 and PtcCO2 were constantly monitored during NIHFOV. The medium PtcCO2 under NIHFOV increased lightly by 4.1 mmHg (interquartile range [IQR], 4-6 mmHg) compared with FB (t = 17.676, P < 0.001). No hypercapnia was found, PtcO2 increased significantly in all volunteers during NIHFOV (t = 25.453, P < 0.001). There was no significant difference in pulse rate between the two data sets (t = 1.257, P = 0.233). NIHFOV is easy to master in healthy volunteers to minimize respiratory movement with good tolerability and reproducibility. It is a feasible approach for lung motion control and could potentially be applied in accurate radiotherapy including carbon-ion radiotherapy through suppression of respiratory movement.
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Affiliation(s)
- Yanshan Zhang
- Heavy Ion Center, Wuwei Cancer Hospital, No. 31 Sanitary Lane, Haizang Road, Wuwei, 733000 Gansu Province China
| | - Xiaojun Li
- Heavy Ion Center, Wuwei Cancer Hospital, No. 31 Sanitary Lane, Haizang Road, Wuwei, 733000 Gansu Province China
| | - Yihe Zhang
- Heavy Ion Center, Wuwei Cancer Hospital, No. 31 Sanitary Lane, Haizang Road, Wuwei, 733000 Gansu Province China
| | - Yancheng Ye
- Heavy Ion Center, Wuwei Cancer Hospital, No. 31 Sanitary Lane, Haizang Road, Wuwei, 733000 Gansu Province China
| | - Yee-Min Jen
- Heavy Ion Center, Wuwei Cancer Hospital, No. 31 Sanitary Lane, Haizang Road, Wuwei, 733000 Gansu Province China ,Department of Radiation Oncology, Yee Zen General Hospital, 30, Yangxing North Rd, Yang Mei District, Tao Yuan City, Taiwan
| | - Xin Pan
- Heavy Ion Center, Wuwei Cancer Hospital, No. 31 Sanitary Lane, Haizang Road, Wuwei, 733000 Gansu Province China
| | - Xiaowei Li
- Heavy Ion Center, Wuwei Cancer Hospital, No. 31 Sanitary Lane, Haizang Road, Wuwei, 733000 Gansu Province China
| | - Tianyan Qin
- Heavy Ion Center, Wuwei Cancer Hospital, No. 31 Sanitary Lane, Haizang Road, Wuwei, 733000 Gansu Province China
| | - Pengqing Li
- Heavy Ion Center, Wuwei Cancer Hospital, No. 31 Sanitary Lane, Haizang Road, Wuwei, 733000 Gansu Province China
| | - Caixia Lv
- Heavy Ion Center, Wuwei Cancer Hospital, No. 31 Sanitary Lane, Haizang Road, Wuwei, 733000 Gansu Province China
| | - Ying Qi
- Heavy Ion Center, Wuwei Cancer Hospital, No. 31 Sanitary Lane, Haizang Road, Wuwei, 733000 Gansu Province China
| | - Xin Wang
- Heavy Ion Center, Wuwei Cancer Hospital, No. 31 Sanitary Lane, Haizang Road, Wuwei, 733000 Gansu Province China
| | - Yuling Yang
- Heavy Ion Center, Wuwei Cancer Hospital, No. 31 Sanitary Lane, Haizang Road, Wuwei, 733000 Gansu Province China
| | - Tong Ma
- Heavy Ion Center, Wuwei Cancer Hospital, No. 31 Sanitary Lane, Haizang Road, Wuwei, 733000 Gansu Province China
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Nankali S, Hansen R, Worm E, Yates ES, Thomsen MS, Offersen B, Poulsen PR. Accuracy and potential improvements of surface-guided breast cancer radiotherapy in deep inspiration breath-hold with daily image-guidance. Phys Med Biol 2022; 67. [DOI: 10.1088/1361-6560/ac9109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/09/2022] [Indexed: 11/12/2022]
Abstract
Abstract
Objective. Radiotherapy of left-sided breast cancer in deep inspiration breath-hold (DIBH) reduces the heart dose. Surface guided radiotherapy (SGRT) can guide the DIBH, but the accuracy is subject to variations in the chest wall position relative to the patient surface. Approach. In this study, ten left-sided breast cancer patients received DIBH radiotherapy with tangential fields in 15–18 fractions. After initial SGRT setup in free breathing an orthogonal MV/kV image pair was acquired during SGRT-guided breath-hold. The couch was corrected to align the chest wall during another breath-hold, and a new SGRT reference surface was acquired for the gating. The chest wall position error during treatment was determined from continuous cine MV images in the imager direction perpendicular to the cranio-caudal direction. A treatment error budget was made with individual contributions from the online registration of the setup MV image, the difference in breath-hold level between setup imaging and SGRT reference surface acquisition, the SGRT level during treatment, and intra-fraction shifts of the chest wall relative to the SGRT reference surface. In addition to the original setup protocol (Scenario A), SGRT was also simulated with better integration of image-guidance by capturing either the new reference surface (Scenario B) or the SGRT positional signal (Scenario C) simultaneously with the setup MV image, and accounting for the image-guided couch correction by shifting the SGRT reference surface digitally. Main results. In general, the external SGRT signal correlated well with the internal chest wall position error (correlation coefficient >0.7 for 75% of field deliveries), but external-to-internal target position offsets above 2 mm occasionally occurred (13% of fractions). The PTV margin required to account for the treatment error was 3.5 mm (Scenario A), 3.4 mm (B), and 3.1 mm (C). Significance. Further integration of SGRT with image-guidance may improve treatment accuracy and workflow although the current study did not show large accuracy improvements of scenario B and C compared to scenario A.
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Park J, Yea JW, Oh SA, Park J, Park JW, Lee JE. Efficacy and Optimal Pressure of Continuous Positive Airway Pressure in Intensity-Modulated Radiotherapy for Locally Advanced Lung Cancer. Cancers (Basel) 2022; 14. [PMID: 36077844 DOI: 10.3390/cancers14174308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/31/2022] [Accepted: 08/31/2022] [Indexed: 12/09/2022] Open
Abstract
We aimed to determine the optimal pressure of continuous positive airway pressure (CPAP) for radiotherapy (RT) through changes in the dosimetric parameters and lung volume according to pressure. Patients with locally advanced lung cancer, who underwent CPAP during computed tomography (CT) simulation, were included. The air pressure was raised in five steps of 4, 7, 10, 14, and 17 cmH2O and a CT scan was performed at the baseline and at each pressure step, accompanied by contouring and RT planning. Paired t- and Wilcoxon signed rank tests were used to compare the volumetric and dosimetric parameters according to pressure and interpressure. A total of 29 patients were selected, and 158 CT datasets were obtained. The lung volume increased significantly at all pressures (p < 0.01). The Dmean of the lung decreased significantly from 7 cmH2O (p < 0.01), the V5, V10, V15, and V20 of the lung decreased significantly from 7 cmH2O with increasing pressure, and the Dmean and V5 of the heart decreased significantly from 14 cmH2O with increasing pressure. The V50 showed no significant differences at any pressure. We recommend the use of at least 7 cmH2O with 14 cmH2O as the optimal pressure to achieve the effect of heart preservation.
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van Kesteren Z, Veldman JK, Parkes MJ, Stevens MF, Balasupramaniam P, van den Aardweg JG, van Tienhoven G, Bel A, van Dijk IWEM. Quantifying the reduction of respiratory motion by mechanical ventilation with MRI for radiotherapy. Radiat Oncol 2022; 17:99. [PMID: 35597956 PMCID: PMC9123684 DOI: 10.1186/s13014-022-02068-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/12/2022] [Indexed: 12/13/2022] Open
Abstract
Background Due to respiratory motion, accurate radiotherapy delivery to thoracic and abdominal tumors is challenging. We aimed to quantify the ability of mechanical ventilation to reduce respiratory motion, by measuring diaphragm motion magnitudes in the same volunteers during free breathing (FB), mechanically regularized breathing (RB) at 22 breaths per minute (brpm), variation in mean diaphragm position across multiple deep inspiration breath-holds (DIBH) and diaphragm drift during single prolonged breath-holds (PBH) in two MRI sessions. Methods In two sessions, MRIs were acquired from fifteen healthy volunteers who were trained to be mechanically ventilated non-invasively We measured diaphragm motion amplitudes during FB and RB, the inter-quartile range (IQR) of the variation in average diaphragm position from one measurement over five consecutive DIBHs, and diaphragm cranial drift velocities during single PBHs from inhalation (PIBH) and exhalation (PEBH) breath-holds. Results RB significantly reduced the respiratory motion amplitude by 39%, from median (range) 20.9 (10.6–41.9) mm during FB to 12.8 (6.2–23.8) mm. The median IQR for variation in average diaphragm position over multiple DIBHs was 4.2 (1.0–23.6) mm. During single PIBHs with a median duration of 7.1 (2.0–11.1) minutes, the median diaphragm cranial drift velocity was 3.0 (0.4–6.5) mm/minute. For PEBH, the median duration was 5.8 (1.8–10.2) minutes with 4.4 (1.8–15.1) mm/minute diaphragm drift velocity. Conclusions Regularized breathing at a frequency of 22 brpm resulted in significantly smaller diaphragm motion amplitudes compared to free breathing. This would enable smaller treatment volumes in radiotherapy. Furthermore, prolonged breath-holding from inhalation and exhalation with median durations of six to seven minutes are feasible. Trial registration Medical Ethics Committee protocol NL.64693.018.18.
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Affiliation(s)
- Z van Kesteren
- Department of Radiation Oncology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
| | - J K Veldman
- Department of Radiation Oncology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - M J Parkes
- Department of Radiation Oncology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - M F Stevens
- Department of Anesthesiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.,Department of Anesthesiology, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - P Balasupramaniam
- Department of Radiation Oncology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - J G van den Aardweg
- Department of Pulmonology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - G van Tienhoven
- Department of Radiation Oncology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - A Bel
- Department of Radiation Oncology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - I W E M van Dijk
- Department of Radiation Oncology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
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Liang E, Dolan JL, Morris ED, Vono J, Bazan LF, Lu M, Glide-Hurst CK. Application of Continuous Positive Airway Pressure for Thoracic Respiratory Motion Management: An Assessment in a Magnetic Resonance Imaging–Guided Radiation Therapy Environment. Adv Radiat Oncol 2022; 7:100889. [PMID: 35198838 PMCID: PMC8844850 DOI: 10.1016/j.adro.2021.100889] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 12/06/2021] [Indexed: 12/22/2022] Open
Abstract
Purpose Patient tolerability of magnetic resonance (MR)–guided radiation treatment delivery is limited by the need for repeated deep inspiratory breath holds (DIBHs). This volunteer study assessed the feasibility of continuous positive airway pressure (CPAP) with and without DIBH for respiratory motion management during radiation treatment with an MR-linear accelerator (MR-linac). Methods and Materials MR imaging safety was first addressed by placing the CPAP device in an MR-safe closet and configuring a tube circuit via waveguide to the magnet bore. Reproducibility and linearity of the final configuration were assessed. Six healthy volunteers underwent thoracic imaging in a 0.35T MR-linac, with one free breathing (FB) and 2 DIBH acquisitions being obtained at 5 pressures from 0 to 15 cm-H2O. Lung and heart volumes and positions were recorded; repeatability was assessed by comparing 2 consecutive DIBH scans. Blinded reviewers graded images for motion artifact using a 3-point grading scale. Participants completed comfort and perception surveys before and after imaging sessions. Results Compared with FB alone, FB-10, FB-12, and FB-15 cm H2O significantly increased lung volumes (+23%, +34%, +44%; all P <.05) and inferiorly displaced the heart (0.86 cm, 0.96 cm, 1.18 cm; all P < . 05). Lung volumes were significantly greater with DIBH-0 cm H2O compared with FB-15 cm H2O (+105% vs +44%, P = .01), and DIBH-15 cm H2O yielded additional volume increase (+131% vs +105%, P = .01). Adding CPAP to DIBH decreased lung volume differences between consecutive breath holds (correlation coefficient 0.97 at 15 cm H2O vs 0.00 at 0 cm H2O). The addition of 15 cm H2O CPAP reduced artifact scores (P = .03) compared with FB; all DIBH images (0-15 cm H2O) had less artifact (P < .01). Conclusions This work demonstrates the feasibility of integrating CPAP in an MR-linac environment in healthy volunteers. Extending this work to a larger patient cohort is warranted to further establish the role of CPAP as an alternative and concurrent approach to DIBH in MR-guided radiation therapy.
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Affiliation(s)
- Evan Liang
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
- Corresponding author: Evan Liang, MD
| | - Jennifer L. Dolan
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
| | - Eric D. Morris
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
- Department of Radiation Oncology, University of California, Los Angeles, California
| | - Jonathan Vono
- Department of Pulmonary and Sleep Medicine, Henry Ford Health System, Detroit, Michigan
| | - Luisa F. Bazan
- Department of Pulmonary and Sleep Medicine, Henry Ford Health System, Detroit, Michigan
| | - Mei Lu
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
| | - Carri K. Glide-Hurst
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
- Department of Human Oncology, University of Wisconsin, Madison, Wisconsin
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Weizman N, Baidun K, Goldstein A, Amit U, Saad A, Lawrence YR, Appel S, Orion I, Alezra D, Abrams R, Symon Z, Goldstein J. Initial estimates of continuous positive airway pressure (CPAP) on heart volume, position and motion in patients receiving chest radiation. Med Dosim 2022; 47:191-196. [DOI: 10.1016/j.meddos.2022.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/10/2022] [Accepted: 02/04/2022] [Indexed: 12/25/2022]
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Choi MS, Chang JS, Park RH, Kwon YJ, Kim YB, Moon JY, Yang G, Kim J, Kim JS. Heart-sparing Capability and Positional Reproducibility of Continuous Positive Airway Pressure in Left-sided Breast Radiation Therapy. Pract Radiat Oncol 2022; 12:e368-e375. [DOI: 10.1016/j.prro.2021.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/05/2021] [Accepted: 12/29/2021] [Indexed: 01/01/2023]
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Sprowls CJ, Chu C, Wall PDH, Fontenot JD. Bilevel Positive Airway Pressure Ventilation for Improving Respiratory Reproducibility in Radiation Oncology: A Pilot Study. Adv Radiat Oncol 2021; 7:100780. [PMID: 34825112 PMCID: PMC8603026 DOI: 10.1016/j.adro.2021.100780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/13/2021] [Accepted: 08/15/2021] [Indexed: 11/26/2022] Open
Abstract
Background Strategies for managing respiratory motion, specifically motion-encompassing methods, in radiation therapy typically assume reproducible breathing. In reality, respiratory motion variations occur and ultimately cause tumor motion variations, which can result in differences between the planned and delivered dose distributions. Therefore, breathing guidance techniques have been investigated to improve respiratory reproducibility. To our knowledge, bilevel positive airway pressure (BIPAP) ventilation assistance has not been previously investigated as a technique for improving respiratory reproducibility and is the focus of this work. Methods and Materials Ten patients undergoing radiation therapy treatment for cancers affected by respiratory motion (eg, lung and esophagus) participated in sessions in which their breathing was recorded during their course of treatment; these sessions occurred either before or after radiation treatments. Both unassisted free-breathing (FB) and BIPAP ventilation-assisted respiratory volume data were collected from each patient using spirometry. Patients used 2 different BIPAP ventilators (fixed BIPAP and flexible BIPAP), each configured to deliver the same volume of air per breath (ie, tidal volume). The flexible BIPAP ventilator permitted patient triggering (ie, it permitted patients to initiate each breath), and the fixed BIPAP did not. Intrasession and intersession metrics quantifying tidal volume variations were calculated and compared between the specific breathing platforms (FB or BIPAP). In addition, patient tolerance of both BIPAP ventilators was qualitatively assessed through verbal feedback. Results Both BIPAP ventilators were tolerated by patients, although the fixed BIPAP was not as well tolerated as the flexible BIPAP. Both BIPAP ventilators showed significant reductions (P < .05) in intrasession tidal volume variation compared with FB. However, only the fixed BIPAP significantly reduced the intersession tidal volume variation compared with FB. Conclusions Based on the established correlation between tidal volume and tumor motion, any reduction of the tidal volume variation could result in reduced tumor motion variation. Fixed BIPAP ventilation was found to be tolerated by patients and was shown to significantly reduce intrasession and intersession tidal volume variations compared with FB. Therefore, future investigation into the potential of fixed BIPAP ventilation is warranted to define the possible clinical benefits.
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Affiliation(s)
- Cameron J Sprowls
- Department of Physics and Astronomy, Louisiana State University and Agricultural and Mechanical College, Baton Rouge, Louisiana
| | - Connel Chu
- Department of Physics, Mary Bird Perkins Cancer Center, Baton Rouge, Louisiana
| | - Phillip D H Wall
- Department of Physics and Astronomy, Louisiana State University and Agricultural and Mechanical College, Baton Rouge, Louisiana
| | - Jonas D Fontenot
- Department of Physics and Astronomy, Louisiana State University and Agricultural and Mechanical College, Baton Rouge, Louisiana.,Department of Physics, Mary Bird Perkins Cancer Center, Baton Rouge, Louisiana
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Kim J, Han MC, Chang JS, Hong CS, Kim KH, Byun HK, Park RH, Koom WS, Park SY, Kim JS. Development of a Margin Determination Framework for Tumor-Tracking Radiation Therapy With Intraoperatively Implanted Fiducial Markers. Front Oncol 2021; 11:753246. [PMID: 34692536 PMCID: PMC8529155 DOI: 10.3389/fonc.2021.753246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 09/16/2021] [Indexed: 12/03/2022] Open
Abstract
PURPOSE To develop an internal target volume (ITV) margin determination framework (or decision-supporting framework) for treating multiple lung metastases using CyberKnife Synchrony with intraoperatively implanted fiducial markers (IIFMs). The feasibility of using non-ideally implanted fiducial markers (a limited number and/or far from a target) for tracking-based lung stereotactic ablative radiotherapy (SABR) was investigated. METHODS In the developed margin determination framework, an optimal set of IIFMs was determined to minimize a tracking uncertainty-specific ITV (ITVtracking) margin (margin required to cover target-to-marker motion discrepancy), i.e., minimize the motion discrepancies between gross tumor volume (GTV) and the selected set of fiducial markers (FMs). The developed margin determination framework was evaluated in 17 patients with lung metastases. To automatically calculate the respiratory motions of the FMs, a template matching-based FM tracking algorithm was developed, and GTV motion was manually measured. Furthermore, during-treatment motions of the selected FMs were analyzed using log files and compared with those calculated using 4D CTs. RESULTS For 41 of 42 lesions in 17 patients (97.6%), an optimal set of the IIFMs was successfully determined, requiring an ITVtracking margin less than 5 mm. The template matching-based FM tracking algorithm calculated the FM motions with a sub-millimeter accuracy compared with the manual measurements. The patient respiratory motions during treatment were, on average, significantly smaller than those measured at simulation for the patient cohort considered. CONCLUSION Use of the developed margin determination framework employing CyberKnife Synchrony with a limited number of IIFMs is feasible for lung SABR.
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Affiliation(s)
- Jihun Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea
| | - Min Cheol Han
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea
| | - Jee Suk Chang
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea
| | - Chae-Seon Hong
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyung Hwan Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hwa Kyung Byun
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea
| | - Ryeong Hwang Park
- Department of Radiation Oncology, Yonsei Cancer Center, Seoul, South Korea
| | - Woong Sub Koom
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea
| | - Seong Yong Park
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Sung Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea
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Gaudreault M, Siva S, Kron T, Hardcastle N. Reducing the impact on renal function of kidney SABR through management of respiratory motion. Phys Med 2021; 89:72-79. [PMID: 34352678 DOI: 10.1016/j.ejmp.2021.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 01/18/2023] Open
Abstract
PURPOSE Stereotactic ablative body radiotherapy (SABR) is as a viable treatment option to treat kidney cancer. This study quantifies dose reduction to non-tumour ipsilateral kidney and estimated renal function gain from elimination of respiratory motion. METHODS We reviewed 62 previously treated kidney SABR patients. The gross tumour volume (GTV) was segmented in each phase of a four-dimensional CT (4DCT). Tumour motion amplitude (TMA) was obtained from the GTV centroid on each phase. Low modulation, motion managed (MM) plans were generated on the exhale phase image. Internal target volume (ITV)-based plans were generated on the 4DCT average intensity projection. To estimate delivered kidney dose, the ITV-based plan was copied ten times to the exhale phase image, with isocentre located at the GTV centroid position in each phase. The dose was calculated and averaged to result in non-motion managed plans. Difference in ipsilateral kidney volume receiving 50% of the prescription dose (V50%) and estimated glomerular filtration rate (GFR) change were compared between ITV and MM plans. RESULTS The mean ± st.dev. TMA was 0.79 ± 0.49 cm. Removing respiratory motion reduced ipsilateral kidney V50% (slope of the difference = 12 cc/cm of TMA, Pearson-r = 0.69, p-value <10-9), and estimated GFR was improved (slope = 4.4 %/cm of TMA, Pearson-r = 0.85, p-value < 10-10). CONCLUSIONS We have quantified the improvement in healthy kidney dose when removing respiratory motion from kidney SABR plans, and demonstrated an expected gain in GFR of 4.4 %/cm of motion removed.
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Affiliation(s)
- Mathieu Gaudreault
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria 3000, Australia.
| | - Shankar Siva
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria 3000, Australia; Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia
| | - Tomas Kron
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria 3000, Australia; Centre for Medical Radiation Physics, University of Wollongong, NSW 2522, Australia
| | - Nicholas Hardcastle
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria 3000, Australia; Centre for Medical Radiation Physics, University of Wollongong, NSW 2522, Australia
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Moore A, Kindler MJ, Allen AM. Use of Continuous Positive Airway Pressure (CPAP) to Limit Diaphragm Motion-A Novel Approach for Definitive Radiation Therapy for Inoperable Pleural Mesothelioma: A Pilot Study. Biology (Basel) 2021; 10:biology10080711. [PMID: 34439944 PMCID: PMC8389276 DOI: 10.3390/biology10080711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/11/2021] [Accepted: 07/21/2021] [Indexed: 11/29/2022]
Abstract
Simple Summary Radiotherapy is an important part of the multimodality approach to treating malignant pleural mesothelioma. In recent studies there is a new trend to treat patients with intact lungs instead of following surgery. This treatment creates significant concerns regarding lung toxicity. We describe two methods to reduce that toxicity. One is the use of constant pulmonary airway pressure (CPAP) to inflate the lungs during treatment. The second is utilizing a novel method of planning and delivering radiotherapy called volumetric modulated arc therapy (VMAT). Abstract Malignant pleural mesothelioma (MPM) is a deadly disease and radiotherapy (RT) plays an important role in its management. Recent developments in technique have made it is possible to deliver RT to MPM in the intact lung. However, it is imperative to reduce normal lung doses. We present a pilot study examining the use of CPAP and VMAT radiotherapy to reduce toxicity when treating MPM, involving three consecutive patients with MPM, not amenable to surgery, who were treated according to Helsinki committee approval. Patients were simulated using four-dimentional CT simulation with the assistance of CPAP lung inflation, then were treated using both IMRT and VMAT techniques. Radiation lung dose was optimized based on accepted lung dose constraints. Patients were followed for toxicity as well as local control and survival. Results: Three patients were treated with CPAP-based IMRT treatment. These patients tolerated the treatment and DVH constraints were able to be met. The comparison plans among the four VMAT arcs and the IMRT static field treatment were able to accomplish the treatment planning objectives without significant advantages with either technique. The treatment combined with CPAP reduced the normal lung dose in MPM patients with intact lungs. This technique is worthy of further investigation.
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Affiliation(s)
- Assaf Moore
- Department of Radiotherapy, Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel; (A.M.); (M.J.K.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Marc J. Kindler
- Department of Radiotherapy, Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel; (A.M.); (M.J.K.)
| | - Aaron Max Allen
- Department of Radiotherapy, Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel; (A.M.); (M.J.K.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Correspondence: ; Tel.: +972-39377960
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Gutiérrez E, Sánchez I, Díaz O, Valles A, Balderrama R, Fuentes J, Lara B, Olimón C, Ruiz V, Rodríguez J, Bayardo LH, Chan M, Villafuerte CJ, Padayachee J, Sun A. Current Evidence for Stereotactic Body Radiotherapy in Lung Metastases. ACTA ACUST UNITED AC 2021; 28:2560-2578. [PMID: 34287274 PMCID: PMC8293144 DOI: 10.3390/curroncol28040233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 12/25/2022]
Abstract
Lung metastases are the second most common malignant neoplasms of the lung. It is estimated that 20–54% of cancer patients have lung metastases at some point during their disease course, and at least 50% of cancer-related deaths occur at this stage. Lung metastases are widely accepted to be oligometastatic when five lesions or less occur separately in up to three organs. Stereotactic body radiation therapy (SBRT) is a noninvasive, safe, and effective treatment for metastatic lung disease in carefully selected patients. There is no current consensus on the ideal dose and fractionation for SBRT in lung metastases, and it is the subject of study in ongoing clinical trials, which examines different locations in the lung (central and peripheral). This review discusses current indications, fractionations, challenges, and technical requirements for lung SBRT.
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Affiliation(s)
- Enrique Gutiérrez
- Princess Margaret Cancer Centre, Radiation Medicine Program, University Health Network, Toronto, ON M5G2M9, Canada; (E.G.); (M.C.); (C.J.V.); (J.P.)
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5G2M9, Canada
| | - Irving Sánchez
- Western National Medical Center, Department of Radiation Oncology, Mexican Institute of Social Security (IMSS), Belisario Domínguez 1000, Guadalajara 44340, Jalisco, Mexico; (I.S.); (O.D.); (A.V.); (R.B.); (J.F.); (B.L.); (C.O.); (V.R.); (J.R.); (L.H.B.)
| | - Omar Díaz
- Western National Medical Center, Department of Radiation Oncology, Mexican Institute of Social Security (IMSS), Belisario Domínguez 1000, Guadalajara 44340, Jalisco, Mexico; (I.S.); (O.D.); (A.V.); (R.B.); (J.F.); (B.L.); (C.O.); (V.R.); (J.R.); (L.H.B.)
| | - Adrián Valles
- Western National Medical Center, Department of Radiation Oncology, Mexican Institute of Social Security (IMSS), Belisario Domínguez 1000, Guadalajara 44340, Jalisco, Mexico; (I.S.); (O.D.); (A.V.); (R.B.); (J.F.); (B.L.); (C.O.); (V.R.); (J.R.); (L.H.B.)
| | - Ricardo Balderrama
- Western National Medical Center, Department of Radiation Oncology, Mexican Institute of Social Security (IMSS), Belisario Domínguez 1000, Guadalajara 44340, Jalisco, Mexico; (I.S.); (O.D.); (A.V.); (R.B.); (J.F.); (B.L.); (C.O.); (V.R.); (J.R.); (L.H.B.)
| | - Jesús Fuentes
- Western National Medical Center, Department of Radiation Oncology, Mexican Institute of Social Security (IMSS), Belisario Domínguez 1000, Guadalajara 44340, Jalisco, Mexico; (I.S.); (O.D.); (A.V.); (R.B.); (J.F.); (B.L.); (C.O.); (V.R.); (J.R.); (L.H.B.)
| | - Brenda Lara
- Western National Medical Center, Department of Radiation Oncology, Mexican Institute of Social Security (IMSS), Belisario Domínguez 1000, Guadalajara 44340, Jalisco, Mexico; (I.S.); (O.D.); (A.V.); (R.B.); (J.F.); (B.L.); (C.O.); (V.R.); (J.R.); (L.H.B.)
| | - Cipatli Olimón
- Western National Medical Center, Department of Radiation Oncology, Mexican Institute of Social Security (IMSS), Belisario Domínguez 1000, Guadalajara 44340, Jalisco, Mexico; (I.S.); (O.D.); (A.V.); (R.B.); (J.F.); (B.L.); (C.O.); (V.R.); (J.R.); (L.H.B.)
| | - Víctor Ruiz
- Western National Medical Center, Department of Radiation Oncology, Mexican Institute of Social Security (IMSS), Belisario Domínguez 1000, Guadalajara 44340, Jalisco, Mexico; (I.S.); (O.D.); (A.V.); (R.B.); (J.F.); (B.L.); (C.O.); (V.R.); (J.R.); (L.H.B.)
| | - José Rodríguez
- Western National Medical Center, Department of Radiation Oncology, Mexican Institute of Social Security (IMSS), Belisario Domínguez 1000, Guadalajara 44340, Jalisco, Mexico; (I.S.); (O.D.); (A.V.); (R.B.); (J.F.); (B.L.); (C.O.); (V.R.); (J.R.); (L.H.B.)
| | - Luis H. Bayardo
- Western National Medical Center, Department of Radiation Oncology, Mexican Institute of Social Security (IMSS), Belisario Domínguez 1000, Guadalajara 44340, Jalisco, Mexico; (I.S.); (O.D.); (A.V.); (R.B.); (J.F.); (B.L.); (C.O.); (V.R.); (J.R.); (L.H.B.)
| | - Matthew Chan
- Princess Margaret Cancer Centre, Radiation Medicine Program, University Health Network, Toronto, ON M5G2M9, Canada; (E.G.); (M.C.); (C.J.V.); (J.P.)
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5G2M9, Canada
| | - Conrad J. Villafuerte
- Princess Margaret Cancer Centre, Radiation Medicine Program, University Health Network, Toronto, ON M5G2M9, Canada; (E.G.); (M.C.); (C.J.V.); (J.P.)
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5G2M9, Canada
| | - Jerusha Padayachee
- Princess Margaret Cancer Centre, Radiation Medicine Program, University Health Network, Toronto, ON M5G2M9, Canada; (E.G.); (M.C.); (C.J.V.); (J.P.)
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5G2M9, Canada
| | - Alexander Sun
- Princess Margaret Cancer Centre, Radiation Medicine Program, University Health Network, Toronto, ON M5G2M9, Canada; (E.G.); (M.C.); (C.J.V.); (J.P.)
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5G2M9, Canada
- Correspondence: ; Tel.: +1-41-6946-2853
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Ko H, Chang JS, Moon JY, Lee WH, Shah C, Shim JSA, Han MC, Baek JG, Park RH, Kim YB, Kim JS. Dosimetric Comparison of Radiation Techniques for Comprehensive Regional Nodal Radiation Therapy for Left-Sided Breast Cancer: A Treatment Planning Study. Front Oncol 2021; 11:645328. [PMID: 33912459 PMCID: PMC8072050 DOI: 10.3389/fonc.2021.645328] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/17/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose How modern cardiac sparing techniques and beam delivery systems using advanced x-ray and proton beam therapy (PBT) can reduce incidental radiation exposure doses to cardiac and pulmonary organs individually or in any combination is poorly investigated. Methods Among 15 patients with left-sided breast cancer, partial wide tangential 3D-conformal radiotherapy (3DCRT) delivered in conventional fractionation (CF) or hypofractionated (HF) schedules; PBT delivered in a CF schedule; and volumetric modulated arc therapy (VMAT) delivered in an HF schedule, each under continuous positive airway pressure (CPAP) and free-breathing (FB) conditions, were examined. Target volume coverage and doses to organs-at-risk (OARs) were calculated for each technique. Outcomes were compared with one-way analysis of variance and the Bonferroni test, with p-values <0.05 considered significant. Results Target volume coverage was within acceptable levels in all interventions, except for the internal mammary lymph node D95 (99% in PBT, 90% in VMAT-CPAP, 84% in VMAT-FB, and 74% in 3DCRT). The mean heart dose (MHD) was the lowest in PBT (<1 Gy) and VMAT-CPAP (2.2 Gy) and the highest in 3DCRT with CF/FB (7.8 Gy), respectively. The mean lung dose (MLD) was the highest in 3DCRT-CF-FB (20 Gy) and the lowest in both VMAT-HF-CPAP and PBT (approximately 5-6 Gy). VMAT-HF-CPAP and PBT delivered a comparable maximum dose to the left ascending artery (7.2 and 6.13 Gy, respectively). Conclusions Both proton and VMAT in combination with CPAP can minimize the radiation exposure to heart and lung with optimal target coverage in regional RT for left-sided breast cancer. The clinical relevance of these differences is yet to be elucidated. Continued efforts are needed to minimize radiation exposures during RT treatment to maximize its therapeutic index.
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Affiliation(s)
- Heejoo Ko
- College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jee Suk Chang
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Young Moon
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Won Hee Lee
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Chirag Shah
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States
| | | | - Min Cheol Han
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Jong Geol Baek
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Ryeong Hwang Park
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Yong Bae Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Sung Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
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Caillet V, Zwan B, Briggs A, Hardcastle N, Szymura K, Prodreka A, O’Brien R, Harris BE, Greer P, Haddad C, Jayamanne D, Eade T, Booth J, Keall P. Geometric uncertainty analysis of MLC tracking for lung SABR. ACTA ACUST UNITED AC 2020; 65:235040. [DOI: 10.1088/1361-6560/abb0c6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Reckhow J, Kaidar-Person O, Ben-David MA, Ostrovski A, Ilinsky D, Goldstein J, Symon Z, Galper S. Continuous positive airway pressure with deep inspiration breath hold in left-sided breast radiation therapy. Med Dosim 2020; 46:127-131. [PMID: 33020023 DOI: 10.1016/j.meddos.2020.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/04/2020] [Accepted: 09/20/2020] [Indexed: 11/25/2022]
Abstract
A dosimetric study to evaluate the use of continuous positive airway pressure (CPAP), with free-breathing (CPAP-FB) or with deep inspiration breath hold (DIBH-CPAP) an adjunct and alternative to DIBH to reduce heart and lung dose in the radiation therapy (RT) of breast cancer planned for left side RT with regional nodes and internal mammary. A retrospective analysis of 10 left-sided breast cancer patients whose heart or lung dose constraints were not met after RT planning based on FB or DIBH simulations and were referred for CPAP-based planning. All patients were simulated using FB, DIBH, CPAP-FB, and CPAP-DIBH. Treatment plans were calculated to cover the breast/chest wall and regional nodes using tangential field-in-field technique (FiF). Dose-volume parameters for heart, ipsilateral lung, and contralateral breast were compared using the Wilcoxon signed-rank test. For all RT plans, mean heart dose (Gy) was lower for treatment plans with CPAP: CPAP-FB (mean 3.4 vs 7.4, p = 0.001) and CPAP-DIBH (mean 2.5 vs 7.4, p = 0.006) compared to FB alone. CPAP-DIBH also significantly reduced MHD as compared to DIBH alone (mean 2.5 vs 4.3 Gy, p = 0.013). CPAP-DIBH significantly reduced mean lung dose as compared to both FB (mean 14.4 vs 20.1, p = 0.005) and DIBH alone (mean 14.4 vs 17.4, p = 0.007). Eight of 10 patients did not meet ipsilateral lung V20Gy dose constraints (≥35% of lung receiving 20 Gy) in either the free breathing or DIBH plans, whereas 8 out of 10 met lung V20Gy goal constraints (≤30% of lung receiving 20 Gy) in the CPAP-DIBH plans. Based on the outcomes of our study, CPAP could be a strategy for reducing lung and heart dose, both in patients not able to execute DIBH and as an adjunct in those not deriving sufficient dose reduction from DIBH alone.
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Affiliation(s)
- Jensen Reckhow
- International Health at Ben Gurion University of the Negev, Beer Sheva, Israel; Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | | | | | - Anna Ostrovski
- Radiation Unit, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Dina Ilinsky
- Radiation Unit, Chaim Sheba Medical Center, Ramat Gan, Israel
| | | | - Zvi Symon
- Radiation Unit, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Shira Galper
- Radiation Unit, Chaim Sheba Medical Center, Ramat Gan, Israel
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Allen AM, Ceder YK, Shochat T, Fenig E, Popovtzer A, Bragilofsky D, Alfassy A, Allon H. CPAP (Continuous Positive Airway Pressure) is an effective and stable solution for heart sparing radiotherapy of left sided breast cancer. Radiat Oncol 2020; 15:59. [PMID: 32143658 PMCID: PMC7060550 DOI: 10.1186/s13014-020-01505-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 02/24/2020] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Limiting the heart dose in left sided breast cancer radiotherapy is critical. We sought to study the effect of using CPAP (continuous positive airway pressure) as an aid in reducing heart dose in breast cancer radiotherapy. METHODS Patients with left sided breast cancer receiving adjuvant radiotherapy were enrolled on a prospective IRB (institutional review board) approved clinical trial utilizing CPAP during radiotherapy. Each patient was simulated and planned with and without CPAP and the best dosimetric results determined the patient's treatment. Data on the differences in lung and heart volume and position as well as boost cavity position with and without CPAP were analyzed. RESULTS Twenty-four women from 10/16 to 10/18 were enrolled. Seven patients were not treated on study; only two of these were due to treatment issues. Median age was 54 years. 70% had breast only radiation and 30% were treated to breast\CW (chest wall) and regional nodes. The median lung volume with CPAP was 60% larger than without CPAP. (1637 vs. 996 cc) p < 0.001. The median heart volume decreased 12% with CPAP. (338 vs. 382 cc) In regards to the DVH, CPAP decreased mean heart dose from 3.02 to 1.6Gy (p = .0075) and V20 of the lungs from 17.1 to 13.8 with CPAP but this was not significant. CONCLUSION CPAP assisted radiotherapy was tolerable and produced superior treatment plans in left sided breast cancer. This method is worthy of further investigation as a method to normal tissue sparing treatment of left sided breast cancer patients.
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Affiliation(s)
- Aaron M Allen
- Department of Radiotherapy, Davidoff Center Rabin Medical Center and Sackler Faculty of Medicine Tel Aviv University, 49 Jabotinksi St, 49100, Petach Tikvah, Israel.
| | - Yasmin Korzets Ceder
- Department of Radiotherapy, Davidoff Center Rabin Medical Center and Sackler Faculty of Medicine Tel Aviv University, 49 Jabotinksi St, 49100, Petach Tikvah, Israel
| | - Tzippy Shochat
- Department of Radiotherapy, Davidoff Center Rabin Medical Center and Sackler Faculty of Medicine Tel Aviv University, 49 Jabotinksi St, 49100, Petach Tikvah, Israel
| | - Eyal Fenig
- Department of Radiotherapy, Davidoff Center Rabin Medical Center and Sackler Faculty of Medicine Tel Aviv University, 49 Jabotinksi St, 49100, Petach Tikvah, Israel
| | - Aron Popovtzer
- Department of Radiotherapy, Davidoff Center Rabin Medical Center and Sackler Faculty of Medicine Tel Aviv University, 49 Jabotinksi St, 49100, Petach Tikvah, Israel
| | - Dimitry Bragilofsky
- Department of Radiotherapy, Davidoff Center Rabin Medical Center and Sackler Faculty of Medicine Tel Aviv University, 49 Jabotinksi St, 49100, Petach Tikvah, Israel
| | - Adi Alfassy
- Department of Radiotherapy, Davidoff Center Rabin Medical Center and Sackler Faculty of Medicine Tel Aviv University, 49 Jabotinksi St, 49100, Petach Tikvah, Israel
| | - Helena Allon
- Department of Radiotherapy, Davidoff Center Rabin Medical Center and Sackler Faculty of Medicine Tel Aviv University, 49 Jabotinksi St, 49100, Petach Tikvah, Israel
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Appel S, Bar J, Alezra D, Ben-Ayun M, Rabin-Alezra T, Honig N, Katzman T, Chatterji S, Symon Z, Lawrence YR. Image-guidance triggered adaptive replanning of radiation therapy for locally advanced lung cancer: an evaluation of cases requiring plan adaptation. Br J Radiol 2020; 93:20190743. [PMID: 31670581 PMCID: PMC6948072 DOI: 10.1259/bjr.20190743] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/12/2019] [Accepted: 10/28/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Anatomic changes may occur during chemoradiation treatment for lung cancers, requiring adaptive replanning. Here we characterize these cases. METHODS We retrospectively studied lung cancer cases that underwent resimulation and adaptive replanning during 1/2016-3/2019. We compared first and second CT-simulation regarding tumor location, timing of change, tumor volume, anatomical alteration and change in simulation technique. We also compared dosimetric parameters between the plans, recorded local control, and overall survival outcomes. RESULTS Out of 281 patients, 58 underwent replanning (20.6%). Histology included small cell (22.4%) and non-small cell (77.6%). Stage III was in 91.4%. Mean radiation dose of 59.4 Gray (Gy) (range 50-66Gy).Tumor location was peribronchial in 53.5%. Timing of replanning was in the first, second and final third of the treatment course in 26%, 43% and 31% respectively. Changes in gross tumor volume were observed in 74%; mean gross tumor volume was 276.7cc vs 192.7 cc (first vs second simulation, p = 0.001). Anatomical changes were identified in 35.4% including pleural fluid accumulation, atelectasis or pneumothorax alteration. Change in simulation technique was performed in 25.9%, including breath-hold or continuous positive airway pressure.Changes in dosimetric parameters when the same technique was used: lung V20Gy 26% (standard deviation, SD 7.6) vs 25.3% (SD 6.6) (p = 0.36), mean lung dose 15.1 Gy (SD 3.7) vs 14.7Gy (SD 3.3) (p = 0.23), heart V40Gy 10.2% (SD13) vs 7.2% (SD 9.8) (p = 0.037). When simulation technique changed: lung V20Gy 30.8% (SD 8.2) vs 27.3% (SD 8) (p = 0.012), mean lung dose 17.3 Gy (SD 4.4) vs 15.3 Gy (SD 3.8) (p = 0.007), heart V40Gy 11.1% (SD 14.7) vs 6.5% (SD 6.7) (p = 0.014).2 year local control was 60.7% (95% confidence interval, 34.5-79.2%), and median overall survival was 19.7 months. CONCLUSION Adaptive replanning of radiation was performed in a fifth of locally advanced lung cancer patients. In most cases tumor volume decreased, or atelectasis resolved, causing mediastinal shifts, which, if unidentified and left uncorrected, may have led to local failure and increased toxicity. The heart V40Gy was reduced significantly in all cases, but significant reduction in lung doses was evident only if simulation technique was altered. ADVANCES IN KNOWLEDGE In locally advanced lung cancer image-guidance with cone beam CT can detect significant mediastinal shifts and gross tumor volume changes that raise the need for adaptive replanning. Image guidance-triggered adaptive replanning should be added to the armament of advanced radiation treatment planning in locally advanced lung cancer.
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Affiliation(s)
- Sarit Appel
- Radiation Oncology, Institute Of Oncology, Chaim Sheba Medical Center affiliated to Tel Aviv University, Sackler faculty of medicine, Ramat Gan, Israel
| | - Jair Bar
- Medical Oncology, Institute of Oncology, Chaim Sheba Medical Center, affiliated to Tel Aviv University, Sackler faculty of medicine, Ramat Gan, Israel
| | - Dror Alezra
- Radiation Oncology, Institute Of Oncology, Chaim Sheba Medical Center affiliated to Tel Aviv University, Sackler faculty of medicine, Ramat Gan, Israel
| | - Maoz Ben-Ayun
- Radiation Oncology, Institute Of Oncology, Chaim Sheba Medical Center affiliated to Tel Aviv University, Sackler faculty of medicine, Ramat Gan, Israel
| | | | - Nir Honig
- Radiation Oncology, Institute Of Oncology, Chaim Sheba Medical Center affiliated to Tel Aviv University, Sackler faculty of medicine, Ramat Gan, Israel
| | - Tamar Katzman
- Radiation Oncology, Institute Of Oncology, Chaim Sheba Medical Center affiliated to Tel Aviv University, Sackler faculty of medicine, Ramat Gan, Israel
| | - Sumit Chatterji
- Department of Pulmonology, Chaim Sheba Medical Center affiliated to Tel Aviv University, Sackler faculty of medicine, Israel, Ramat Gan, Israel
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Wang P, Tang S, Leach K, Mangona V, Simone CB, Langen K, Chang C. Proton pencil beam scanning treatment with feedback based voluntary moderate breath hold. Med Dosim 2019; 45:e10-e15. [PMID: 31870600 DOI: 10.1016/j.meddos.2019.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 10/18/2019] [Accepted: 11/18/2019] [Indexed: 11/27/2022]
Abstract
Introduction The aim of this article is to introduce a novel protocol for proton pencil beam scanning treatment with moderate deep inspiration breath hold (mDIBH) and report on our clinical implementation results. Methods Three computed tomography (CT) scannings to build the patient's anatomy model were performed during the patient's voluntary mDIBH. All 3 CT scans were used in the optimization during the treatment planning process. Both orthogonal kV imaging and cone-beam computed tomography (CBCT) were implemented for patient alignment with BH prior to the treatment. The BH CBCT images were analyzed for BH reproducibility and the virtual total dose (VTD) retrospectively. To find the VTD, a series of deformable image registrations (DIR) were performed between CBCT and pCT. The effect of the variation of lung density on the dose distribution was also analyzed in the study. Results The values of the mean, standard deviation, maximum, and minimum of the tumor location difference between the CBCT and pCT were 1.9, 1.6, 4.7, and 0.0 mm, respectively. The percentage difference in D99% of CTVs between VTD and the nominal plan was within 1.5%. Conclusions The feedback-based voluntary moderate BH proton PBS treatment was successfully performed in our clinic. This study shows that there is a potential to implement the BH treatment widely in proton centers.
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Affiliation(s)
- Peng Wang
- Department of Radiation Oncology, Inova Health System, Falls Church, VA, USA.
| | - Shikui Tang
- Texas Center for Proton Therapy, Irving, TX, USA
| | - Karla Leach
- Texas Center for Proton Therapy, Irving, TX, USA
| | | | | | | | - Chang Chang
- California Protons Ca Therapy Center, San Diego, CA, USA
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Kil WJ. Novel Use of Continuous Positive Airway Pressure Permits Heart- and Lung-Sparing Mediastinal Involved-Site Radiation Therapy for Patient With Hodgkin Lymphoma in Community Clinic When Deep Inspiration Breath-Hold Technique Is Not Available. Pract Radiat Oncol 2019; 9:142-146. [DOI: 10.1016/j.prro.2019.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/11/2019] [Accepted: 01/27/2019] [Indexed: 11/26/2022]
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Van Ooteghem G, Dasnoy-Sumell D, Lambrecht M, Reychler G, Liistro G, Sterpin E, Geets X. Mechanically-assisted non-invasive ventilation: A step forward to modulate and to improve the reproducibility of breathing-related motion in radiation therapy. Radiother Oncol 2019; 133:132-139. [PMID: 30935569 DOI: 10.1016/j.radonc.2018.12.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 12/27/2018] [Accepted: 12/27/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE When using highly conformal radiotherapy techniques, a stabilized breathing pattern could greatly benefit the treatment of mobile tumours. Therefore, we assessed the feasibility of Mechanically-assisted non-invasive ventilation (MANIV) on unsedated volunteers, and its ability to stabilize and modulate the breathing pattern over time. MATERIALS AND METHODS Twelve healthy volunteers underwent 2 sessions of dynamic MRI under 4 ventilation modes: spontaneous breathing (SP), volume-controlled mode (VC) that imposes regular breathing in physiologic conditions, shallow-controlled mode (SH) that intends to lower amplitudes while increasing the breathing rate, and slow-controlled mode (SL) that mimics end-inspiratory breath-holds. The last 3 modes were achieved under respirator without sedation. The motion of the diaphragm was tracked along the breathing cycles on MRI images and expressed in position, breathing amplitude, and breathing period for intra- and inter-session analyses. In addition, end-inspiratory breath-hold duration and position stability were analysed during the SL mode. RESULTS MANIV was well-tolerated by all volunteers, without adverse event. The MRI environment led to more discomfort than MANIV itself. Compared to SP, VC and SH modes improved the inter-session reproducibility of the amplitude (by 43% and 47% respectively) and significantly stabilized the intra- and inter-session breathing rate (p < 0.001). Compared to VC, SH mode significantly reduced the intra-session mean amplitude (36%) (p < 0.002), its variability (42%) (p < 0.001), and the intra-session baseline shift (26%) (p < 0.001). The SL mode achieved end-inspiratory plateaus lasting more than 10 s. CONCLUSION MANIV offers exciting perspectives for motion management. It improves its intra- and inter-session reproducibility and should facilitate respiratory tracking, gating or margin techniques for both photon and proton treatments.
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Affiliation(s)
- Geneviève Van Ooteghem
- Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), Molecular Imaging, Radiotherapy and Oncology (MIRO), Brussels, Belgium; Cliniques Universitaires Saint Luc, Department of Radiation Oncology, Brussels, Belgium.
| | - Damien Dasnoy-Sumell
- Université Catholique de Louvain, ImagX-R, Institute of Information and Communication Technologies, Electronics and Applied Mathematics, Louvain-La-Neuve, Belgium.
| | - Maarten Lambrecht
- University Hospitals Leuven Gasthuisberg, Department of Radiation Oncology, Leuven, Belgium; Katholieke Universiteit Leuven, Department of Oncology, Laboratory of Experimental Radiotherapy, Leuven, Belgium.
| | - Grégory Reychler
- Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ENT & Dermatologie, Brussels, Belgium.
| | - Giuseppe Liistro
- Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ENT & Dermatologie, Brussels, Belgium.
| | - Edmond Sterpin
- Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), Molecular Imaging, Radiotherapy and Oncology (MIRO), Brussels, Belgium; Katholieke Universiteit Leuven, Department of Oncology, Laboratory of Experimental Radiotherapy, Leuven, Belgium.
| | - Xavier Geets
- Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), Molecular Imaging, Radiotherapy and Oncology (MIRO), Brussels, Belgium; Cliniques Universitaires Saint Luc, Department of Radiation Oncology, Brussels, Belgium.
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Di Perri D, Colot A, Delor A, Ghoul R, Janssens G, Lacroix V, Matte P, Robert A, Souris K, Geets X. Effect of continuous positive airway pressure administration during lung stereotactic ablative radiotherapy: a comparative planning study. Strahlenther Onkol 2018; 194:591-9. [DOI: 10.1007/s00066-018-1278-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 01/29/2018] [Indexed: 12/25/2022]
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Abstract
Patient motion can cause misalignment of the tumour and toxicities to the healthy lung tissue during lung stereotactic body radiation therapy (SBRT). Any deviations from the reference setup can miss the target and have acute toxic effects on the patient with consequences onto its quality of life and survival outcomes. Correction for motion, either immediately prior to treatment or intra-treatment, can be realized with image-guided radiation therapy (IGRT) and motion management devices. The use of these techniques has demonstrated the feasibility of integrating complex technology with clinical linear accelerator to provide a higher standard of care for the patients and increase their quality of life.
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Affiliation(s)
- Vincent Caillet
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia; School of Physics, University of Sydney, Sydney, Australia.
| | - Jeremy T Booth
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia; School of Physics, University of Sydney, Sydney, Australia
| | - Paul Keall
- School of Medicine, University of Sydney, Sydney, Australia
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Iwata H, Ishikura S, Murai T, Iwabuchi M, Inoue M, Tatewaki K, Ohta S, Yokota N, Shibamoto Y. A phase I/II study on stereotactic body radiotherapy with real-time tumor tracking using CyberKnife based on the Monte Carlo algorithm for lung tumors. Int J Clin Oncol 2017; 22:706-714. [DOI: 10.1007/s10147-017-1123-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 04/05/2017] [Indexed: 12/25/2022]
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Péguret N, Ozsahin M, Zeverino M, Belmondo B, Durham AD, Lovis A, Simons J, Long O, Duclos F, Prior J, Denys A, Beigelman C, Sozzi WJ, Grant K, Gautier-Dechaud V, Peters S, Vienne M, Moeckli R, Bourhis J. Apnea-like suppression of respiratory motion: First evaluation in radiotherapy. Radiother Oncol 2016; 118:220-6. [PMID: 26979264 DOI: 10.1016/j.radonc.2015.10.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 10/11/2015] [Accepted: 10/11/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Compensation for respiratory motion is needed while administering radiotherapy (RT) to tumors that are moving with respiration to reduce the amount of irradiated normal tissues and potentially decrease radiation-induced collateral damages. The purpose of this study was to test a new ventilation system designed to induce apnea-like suppression of respiratory motion and allow long enough breath hold durations to deliver complex RT. MATERIAL AND METHODS The High Frequency Percussive Ventilation system was initially tested in a series of 10 volunteers and found to be well tolerated, allowing a median breath hold duration of 11.6 min (range 3.9-16.5 min). An evaluation of this system was subsequently performed in 4 patients eligible for adjuvant breast 3D conformal RT, for lung stereotactic body RT (SBRT), lung volumetric modulated arc therapy (VMAT), and VMAT for palliative pleural metastases. RESULTS When compared to free breathing (FB) and maximal inspiration (MI) gating, this Percussion Assisted RT (PART) offered favorable dose distribution profiles in 3 out of the 4 patients tested. PART was applied in these 3 patients with good tolerance, without breaks during the "beam on time period" throughout the overall courses of RT. The mean duration of the apnea-like breath hold that was necessary for delivering all the RT fractions was 7.61 min (SD=2.3). CONCLUSIONS This first clinical implementation of PART was found to be feasible, tolerable and offers new opportunities in the field of RT for suppressing respiratory motion.
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Appel S, Weizman N, Davidson T, Urban D, Lawrence YR, Symon Z, Goldstein J. Reexpansion of atelectasis caused by use of continuous positive airway pressure (CPAP) before radiation therapy (RT). Adv Radiat Oncol 2016; 1:136-140. [PMID: 28740882 PMCID: PMC5506747 DOI: 10.1016/j.adro.2016.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 03/14/2016] [Accepted: 03/16/2016] [Indexed: 11/29/2022] Open
Abstract
Introduction Although radiation therapy (RT) is an effective treatment for malignant atelectasis, its accurate delivery is challenging because of difficulty differentiating between tumor and atelectatic lung. Furthermore, reexpansion of lung during treatment repositions tumor and normal structures necessitating replanning to ensure treatment accuracy. Facilitating lung reexpansion before initiation of RT may improve RT treatment accuracy, spare normal tissue, and reduce obstructive symptoms. We report a case of reexpansion of right upper lobe (RUL) atelectasis caused by use of continuous positive airway pressure (CPAP) before RT. Case report A 52-year-old woman presented with dyspnea and cough. Imaging studies showed an RUL mass with atelectasis. Bronchoscopy showed extrinsic compression of the RUL and middle lobe bronchi. Biopsy showed small cell lung cancer. Staging with positron emission tomography-computed tomography (CT) and contrast enhanced CT of brain showed no other disease. Following 4 cycles of platinum-based chemotherapy, CT imaging showed a decrease in tumor volume, but persistent RUL atelectasis. She agreed to participate in an institutional study to evaluate the use of CPAP to reduce respiratory motion and immobilize tumors during RT. During CPAP training, she complained of vertigo, headache, and weakness and refused simulation. The next day she reported less dyspnea and completed training and CT simulation without difficulty. CT simulation with CPAP showed reexpansion of the RUL. Lung volume increased from 2170 to 3767 mL (74 %). Gross tumor volume, clinical volume, and planning volume decreased 46%, 45%, and 38%, respectively. Mean lung dose and mean heart dose decreased 20% and 51%, respectively. CPAP was used daily for 1 hour before and during treatment. Cone beam CT scans showed that the RUL remained inflated throughout treatment. Conclusion This is the first reported use of CPAP for reexpansion of atelectasis before RT planning and treatment. Reexpansion of atelectasis improved RT planning, decreased dose to uninvolved lung, and removed the need for replanning. Further study of CPAP as an initial intervention to improve RT delivery in patients with malignant atelectasis is warranted.
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Affiliation(s)
- Sarit Appel
- Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, an affiliate of the Sackler School of Medicine, Tel Aviv University, Tel Aviv Israel
| | - Noam Weizman
- Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, an affiliate of the Sackler School of Medicine, Tel Aviv University, Tel Aviv Israel
| | - Tima Davidson
- Department of Nuclear Medicine, Sheba Medical Center, Tel Hashomer, an affiliate of the Sackler School of Medicine, Tel Aviv University, Tel Aviv Israel
| | - Damien Urban
- Department of Internal Medicine, Sheba Medical Center, Tel Hashomer, an affiliate of the Sackler School of Medicine, Tel Aviv University, Tel Aviv Israel
| | - Yaacov Richard Lawrence
- Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, an affiliate of the Sackler School of Medicine, Tel Aviv University, Tel Aviv Israel
| | - Zvi Symon
- Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, an affiliate of the Sackler School of Medicine, Tel Aviv University, Tel Aviv Israel
| | - Jeffrey Goldstein
- Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, an affiliate of the Sackler School of Medicine, Tel Aviv University, Tel Aviv Israel
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