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Voluntary Breath-hold Technique for Reducing Heart Dose in Left Breast Radiotherapy
Published on: July 3, 2014
A Preliminary Efficiency Evaluation of Upper Abdominal Breath-Hold Radiation Therapy Following Personalized Screening
Briana Farrugia1,2, Caroline Wright2, Kellie Knight2
1Radiation Oncology, Olivia Newton-John Cancer Wellness & Research Centre, Austin Health, Heidelberg, Victoria, Australia.
Purpose:
Assisted breath-hold (BH) is a motion management strategy facilitating safe dose-escalated radiation therapy. Treatment efficiency largely depends on patient training and BH capability, which are crucial for the viability of routine BH treatments. Although strategies to extend BH time exist, the efficiency of upper abdominal radiation using the Active Breathing Coordinator remains unreported. The aim of this prospective study was to undertake a novel evaluation of BH efficiency following personalized technique screening.
Methods And Materials:
Patients presenting for radiation therapy to the upper abdomen, including liver, kidney, pancreas, or adrenal gland, were approached for inclusion. Participants underwent screening to personalize the selection of the BH technique with a prespecified novel decision support algorithm using the Active Breathing Coordinator. BH time, treatment time, and number of BHs were recorded for the first three treatment fractions and used to calculate BH efficiency.
Results:
Sixteen patients underwent treatment following screening and assessment to personalize their BH technique selection. The overall mean BH time was 22.8 (range, 15-30) seconds, and a mean of 10 (range, 5-18) BHs were required to complete each fraction. Descriptive statistics, including Student t tests and linear mixed-effects models, were used to describe the data. The mean cohort efficiency was 0.47 (SD, 0.12). This improved from 0.45 (SD, 0.12) at fraction 1 to 0.50 (SD, 0.13) at fraction 3, regardless of technique. Efficiency was higher in the inspiration BH subgroup (mean, 0.52; SD, 0.12) compared with expiration BH (mean, 0.45; SD, 0.10; P = .060) and deep-inspiration BH (mean, 0.39; SD, 0.09; P = .005). Patients with BH times of 25, 30, and 38 seconds had statistically significantly higher efficiency than patients with 15 seconds, irrespective of BH technique.
Conclusions:
Efficiency improved with increasing BH time. Efforts to improve BH time, such as comprehensive training programs, may aid in achieving the maximum benefit of BH techniques.
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