Active Breathing Coordinator reduces radiation dose to the stomach in patients with left breast cancer

Ying Piao; Hongtao Chen; Fengshun Yuan; Juan Fan; Shihai Wu; Xianming Li; Dong Yang

doi:10.1080/0284186X.2023.2275288

Active Breathing Coordinator reduces radiation dose to the stomach in patients with left breast cancer

Acta Oncol. 2023 Dec;62(12):1873-1879. doi: 10.1080/0284186X.2023.2275288. Epub 2023 Nov 25.

Authors

Ying Piao¹, Hongtao Chen¹, Fengshun Yuan², Juan Fan¹, Shihai Wu¹, Xianming Li¹, Dong Yang¹

Affiliations

¹ Department of Radiation Oncology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, People's Republic of China.
² Sichuan Provincial Center for Disease Control and Prevention, Center for AIDS/STD Control and Prevention, Chengdu, Sichuan, People's Republic of China.

PMID: 37909907
DOI: 10.1080/0284186X.2023.2275288

Abstract

Background/purpose: Gastric dose parameters comparison for deep inspiration breath-hold (DIBH) or free breathing (FB) mode during radiotherapy (RT) for left-sided breast cancer patients (LSBCPs) has not been investigated before. This study aimed to analyze the impact of Active Breath Coordinator (ABC)-DIBH technique on the dose received by the stomach during RT for LSBCPs and to provide organ-specific dosimetric parameters.

Materials and methods: The study included 73 LSBCPs. The dosimetric parameters of the stomach were compared between FB and DIBH mode. The correlation between the stomach volume and dosimetric parameters was analyzed.

Results: Compared to FB mode, statistically significant reductions were observed in gastric dose parameters in ABC-DIBH mode, including Dmax (46.60 vs 17.25, p < 0.001), D1cc (38.42 vs 9.60, p < 0.001), Dmean (4.10 vs 0.80, p < 0.001), V40Gy (0.50 vs 0.00, p < 0.001), V30Gy (6.30 vs 0.00, p < 0.001), V20Gy (20.80 vs 0.00, p < 0.001), V10Gy (51.10 vs 0.77, p < 0.001), and V5Gy (93.20 vs 9.60, p < 0.001). ABC-DIBH increased the distance between the stomach and the breast PTV when compared to FB, from 1.3 cm to 2.8 cm (p < 0.001). Physiologic decrease in stomach volume was not found from FB to ABC-DIBH (415.54 cm³ vs 411.61 cm³, p = 0.260). The stomach volume showed a positive correlation with V40Gy (r² = 0.289; p < 0.05), V30Gy (r² = 0.287; p < 0.05), V20Gy (r² = 0.343; p < 0.05), V10Gy (r² = 0.039; p < 0.001), V5Gy (r² = 0.439; p < 0.001), Dmax (r² = 0.269; p < 0.05) and D1cc (r² = 0.278; p < 0.05) in FB mode. While in ABC-DIBH mode, most stomach dosimetric parameters were not correlated with gastric volume.

Conclusions: The implementation of ABC-DIBH in LSBCPs radiotherapy resulted in lower irradiation of the stomach. Larger stomach volume was associated with statistically significantly higher dose irradiation in FB mode. To reduce radiotherapy related side effects in FB mode, patients should be fast for at least 2 hours before the CT simulation and treatment.

Keywords: ABC-DIBH; Left-sided breast cancer; radiotherapy; stomach dose; stomach volume.

MeSH terms

Breast Neoplasms* / radiotherapy
Breath Holding
Female
Heart / radiation effects
Humans
Organs at Risk / radiation effects
Radiation Dosage
Radiotherapy Dosage
Radiotherapy Planning, Computer-Assisted / methods
Stomach
Unilateral Breast Neoplasms* / radiotherapy