Voluntary versus mechanically-induced deep inspiration breath-hold for left breast cancer: A randomized controlled trial

Loïc Vander Veken; Geneviève Van Ooteghem; Ariane Razavi; Sergio Da Rita Quaresma; Eleonore Longton; Carine Kirkove; Benjamin Ledoux; Ad Vandermeulen; Christel Abdel Massih; Pascale Henderickx; Mortimer Gabriels; Céline Delvaux; Faycal Salah; Aude Vaandering; Xavier Geets

doi:10.1016/j.radonc.2023.109598

Voluntary versus mechanically-induced deep inspiration breath-hold for left breast cancer: A randomized controlled trial

Radiother Oncol. 2023 Jun:183:109598. doi: 10.1016/j.radonc.2023.109598. Epub 2023 Mar 9.

Authors

Affiliations

¹ UCLouvain, Institut de Recherche Experimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), 1200 Brussels, Belgium; Radiation Oncology Department, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium. Electronic address: loic.vanderveken@uclouvain.be.
² UCLouvain, Institut de Recherche Experimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), 1200 Brussels, Belgium; Radiation Oncology Department, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium.
³ Radiation Oncology Department, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium.

PMID: 36898583
DOI: 10.1016/j.radonc.2023.109598

Abstract

Background and purpose: Deep inspiration breath-hold (DIBH) protects critical organs-at-risk (OARs) for adjuvant breast radiotherapy. Guidance systems e.g. surface guided radiation therapy (SGRT) improve the positional breast reproducibility and stability during DIBH. In parallel, OARs sparing with DIBH is enhanced through different techniques e.g. prone position, continuous positive airway pressure (CPAP). By inducing repeated DIBH with the same level of positive pressure, mechanically-assisted and non-invasive ventilation (MANIV) could potentially combine these DIBH optimizations.

Materials and methods: We conducted a randomized, open-label, multicenter and single-institution non-inferiority trial. Sixty-six patients eligible for adjuvant left whole-breast radiotherapy in supine position were equally assigned between mechanically-induced DIBH (MANIV-DIBH) and voluntary DIBH guided by SGRT (sDIBH). The co-primary endpoints were positional breast stability and reproducibility with a non-inferiority margin of 1 mm. Secondary endpoints were tolerance assessed daily via validated scales, treatment time, dose to OARs and their inter-fraction positional reproducibility.

Results: Differences between both arms for positional breast reproducibility and stability occurred at a sub-millimetric level (p < 0.001 for non-inferiority). The left anterior descending artery near-max dose (14,6 ± 12,0 Gy vs. 7,7 ± 7,1 Gy, p = 0,018) and mean dose (5,0 ± 3,5 Gy vs. 3,0 ± 2,0 Gy, p = 0,009) were improved with MANIV-DIBH. The same applied for the V_5Gy of the left ventricle (2,4 ± 4,1 % vs. 0,8 ± 1,6 %, p = 0,001) as well as for the left lung V_20Gy (11,4 ± 2,8 % vs. 9,7 ± 2,7 %, p = 0,019) and V_30Gy (8,0 ± 2,6 % vs. 6,5 ± 2,3 %, p = 0,0018). Better heart's inter-fraction positional reproducibility was observed with MANIV-DIBH. Tolerance and treatment time were similar.

Conclusion: Mechanical ventilation provides the same target irradiation accuracy as with SGRT while better protecting and repositioning OARs.

Keywords: Breast cancer; Deep inspiration breath-hold; Mean heart dose; Mechanical ventilation; Radiotherapy.

Publication types

Randomized Controlled Trial
Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

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