Deep inspiration breath-hold technique for lung tumors: The potential value of target immobilization and reduced lung density in dose escalation Journal Article
| Authors: | Hanley, J.; Debois, M. M.; Mah, D.; Mageras, G. S.; Raben, A.; Rosenzweig, K.; Mychalczak, B.; Schwartz, L. H.; Gloeggler, P. J.; Lutz, W.; Ling, C. C.; Leibel, S. A.; Fuks, Z.; Kutcher, G. J. |
| Article Title: | Deep inspiration breath-hold technique for lung tumors: The potential value of target immobilization and reduced lung density in dose escalation |
| Abstract: | Purpose/Objective: This study evaluates the dosimetric benefits and feasibility of a deep inspiration breath-hold (DIBH) technique in the treatment of lung tumors. The technique has two distinct features-deep inspiration, which reduces lung density, and breath-hold, which immobilizes lung tumors, thereby allowing for reduced margins. Both of these properties can potentially reduce the amount of normal lung tissue in the high-dose region, thus reducing morbidity and improving the possibility of dose escalation.Methods and Materials: Five patients treated for non-small cell lung carcinoma (Stage IIA-IIIB) received computed tomography (CT) scans under 4 respiration conditions: free-breathing, DIBH, shallow inspiration breath-hold, and shallow expiration breath-hold. The free-breathing and DIBH scans were used to generate 3-dimensional conformal treatment plans for comparison, while the shallow inspiration and expiration scans determined the extent of tumor motion under free-breathing conditions. To acquire the breath-hold scans, the patients are brought to reproducible respiration levels using spirometry, and for DIBH, modified slow vital capacity maneuvers. Planning target volumes (PTVs) for free-breathing plans included a margin for setup error (0.75 cm) plus a margin equal to the extent of tumor motion due to respiration (1-2 cm). Planning target volumes for DIBH plans included the same margin for setup error, with a reduced margin for residual uncertainty in tumor position (0.2-0.5 cm) as determined from repeat fluoroscopic movies. To simulate the effects of respiration-gated treatments and estimate the role of target immobilization alone (i.e., without the benefit of reduced lung density), a third plan is generated from the free-breathing scan using a PTV with the same margins as for DIBH plans.Results: The treatment plan comparison suggests that, on average, the DIBH technique can reduce the volume of lung receiving more than 25 Gy by 30% compared to free-breathing plans, while respiration gating can reduce the volume by 18%. The DIBH maneuver was found to be highly reproducible, with intra breath-hold reproducibility of 1.0 (± 0.9) mm and inter breath-hold reproducibility of 2.5 (± 1.6) mm, as determined from diaphragm position. Patients were able to perform 10-13 breath-holds in one session, with a comfortable breath-hold duration of 12-16 s.Conclusion: Patients tolerate DIBH maneuvers well and can perform them in a highly reproducible fashion. Compared to conventional free-breathing treatment, the DIBH technique benefits from reduced margins, as a result of the suppressed target motion, as well as a decreased lung density; both contribute to moving normal lung tissue out of the high-dose region. Because less normal lung tissue is irradiated to high dose, the possibility for dose escalation is significantly improved. Copyright (C) 1999 Elsevier Science Inc. |
| Keywords: | adult; clinical article; aged; middle aged; cancer radiotherapy; computer assisted tomography; lung non small cell cancer; carcinoma, non-small-cell lung; lung neoplasms; tomography, x-ray computed; radiation dosage; feasibility studies; dosimetry; lung; lung carcinoma; density; breath holding; technique; immobilization; inhalation; breath-hold; spirometry; breathing; humans; human; male; female; priority journal; article; respiration gating |
| Journal Title: | International Journal of Radiation Oncology, Biology, Physics |
| Volume: | 45 |
| Issue: | 3 |
| ISSN: | 0360-3016 |
| Publisher: | Elsevier Inc. |
| Date Published: | 1999-10-01 |
| Start Page: | 603 |
| End Page: | 611 |
| Language: | English |
| DOI: | 10.1016/s0360-3016(99)00154-6 |
| PUBMED: | 10524412 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Article -- Export Date: 16 August 2016 -- Source: Scopus |
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