PURPOSE: Active breathing control (ABC) is emerging as a tool to reduce heart and lung dose for lymphoma patients receiving mediastinal radiation therapy (RT). The objective of this study was to report our early institutional experience with this technique, with emphasis on quantifying the changes in normal tissue dose and exploring factors that could be used to select patients with the greatest benefit. METHODS AND MATERIALS: Patients receiving mediastinal involved-field RT (IFRT) for lymphoma were eligible. The ABC was performed using a moderate deep-inspiration breath-hold (mDIBH) technique. All patients were replanned with free-breathing (FB) computed tomographic data sets and comparisons of lung, cardiac, and female breast tissue doses were made between mDIBH and FB plans. Logistic regression models were used to identify factors associated with improvement in mean lung and heart dose with mDIBH. RESULTS: Forty-seven patients were analyzed; the majority (87.2%) had Hodgkin lymphoma. Median prescribed dose was 30 Gy (range, 20-36 Gy), with 78.7% of cases being treated with parallel-opposed beams. The use of mDIBH significantly improved average mean lung dose (FB: 11.0 Gy; mDIBH: 9.5 Gy; P < .0001), lung V20 (28% vs 22%; P < .0001), and mean heart dose (14.3 Gy vs 11.8 Gy; P = .003), but increased the mean breast dose (FB: 3.0 Gy; mDIBH 3.6 Gy; P = .0005). The magnitude of diaphragmatic excursion on the inhale scan was significantly associated with dosimetric improvement in both heart and lung dose with mDIBH. CONCLUSIONS: Mediastinal IFRT for lymphoma delivered with mDIBH can significantly reduce lung and heart dose compared with FB, although not for all patients, and may increase breast dose in females. Its implementation is achievable in both adult and pediatric populations. Further work is necessary to better predict which patients benefit from this technique.
PURPOSE: Active breathing control (ABC) is emerging as a tool to reduce heart and lung dose for lymphomapatients receiving mediastinal radiation therapy (RT). The objective of this study was to report our early institutional experience with this technique, with emphasis on quantifying the changes in normal tissue dose and exploring factors that could be used to select patients with the greatest benefit. METHODS AND MATERIALS: Patients receiving mediastinal involved-field RT (IFRT) for lymphoma were eligible. The ABC was performed using a moderate deep-inspiration breath-hold (mDIBH) technique. All patients were replanned with free-breathing (FB) computed tomographic data sets and comparisons of lung, cardiac, and female breast tissue doses were made between mDIBH and FB plans. Logistic regression models were used to identify factors associated with improvement in mean lung and heart dose with mDIBH. RESULTS: Forty-seven patients were analyzed; the majority (87.2%) had Hodgkin lymphoma. Median prescribed dose was 30 Gy (range, 20-36 Gy), with 78.7% of cases being treated with parallel-opposed beams. The use of mDIBH significantly improved average mean lung dose (FB: 11.0 Gy; mDIBH: 9.5 Gy; P < .0001), lung V20 (28% vs 22%; P < .0001), and mean heart dose (14.3 Gy vs 11.8 Gy; P = .003), but increased the mean breast dose (FB: 3.0 Gy; mDIBH 3.6 Gy; P = .0005). The magnitude of diaphragmatic excursion on the inhale scan was significantly associated with dosimetric improvement in both heart and lung dose with mDIBH. CONCLUSIONS: Mediastinal IFRT for lymphoma delivered with mDIBH can significantly reduce lung and heart dose compared with FB, although not for all patients, and may increase breast dose in females. Its implementation is achievable in both adult and pediatric populations. Further work is necessary to better predict which patients benefit from this technique.
Authors: Richard T Hoppe; Ranjana H Advani; Weiyun Z Ai; Richard F Ambinder; Patricia Aoun; Celeste M Bello; Cecil M Benitez; Philip J Bierman; Kristie A Blum; Robert Chen; Bouthaina Dabaja; Andres Forero; Leo I Gordon; Francisco J Hernandez-Ilizaliturri; Ephraim P Hochberg; Jiayi Huang; Patrick B Johnston; Nadia Khan; David G Maloney; Peter M Mauch; Monika Metzger; Joseph O Moore; David Morgan; Craig H Moskowitz; Carolyn Mulroney; Matthew Poppe; Rachel Rabinovitch; Stuart Seropian; Christina Tsien; Jane N Winter; Joachim Yahalom; Jennifer L Burns; Hema Sundar Journal: J Natl Compr Canc Netw Date: 2015-05 Impact factor: 11.908
Authors: Chelsea C Pinnix; Grace L Smith; Sarah Milgrom; Eleanor M Osborne; Jay P Reddy; Mani Akhtari; Valerie Reed; Isidora Arzu; Pamela K Allen; Christine F Wogan; Michele A Fanale; Yasuhiro Oki; Francesco Turturro; Jorge Romaguera; Luis Fayad; Nathan Fowler; Jason Westin; Loretta Nastoupil; Fredrick B Hagemeister; M Alma Rodriguez; Sairah Ahmed; Yago Nieto; Bouthaina Dabaja Journal: Int J Radiat Oncol Biol Phys Date: 2015-05-01 Impact factor: 7.038
Authors: Laura Ann Rechner; Maja Vestmø Maraldo; Ivan Richter Vogelius; Xiaorong Ronald Zhu; Bouthaina Shbib Dabaja; Nils Patrik Brodin; Peter Meidahl Petersen; Lena Specht; Marianne Camille Aznar Journal: Radiother Oncol Date: 2017-08-30 Impact factor: 6.280
Authors: Andrea Riccardo Filippi; Sofia Meregalli; Anna DI Russo; Mario Levis; Patrizia Ciammella; Michela Buglione; Andrea Emanuele Guerini; Giuseppina De Marco; Vitaliana De Sanctis; Stefano Vagge; Umberto Ricardi; Gabriele Simontacchi Journal: Radiat Oncol Date: 2020-03-12 Impact factor: 3.481
Authors: Chelsea C Pinnix; Jinhai Huo; Sarah A Milgrom; Zeinab Abou Yehia; Michelle Fanale; Yasuhiro Oki; Bouthaina S Dabaja; Grace L Smith Journal: Adv Radiat Oncol Date: 2018-04-24