title: Evaluation of active breathing control-moderate deep inspiration breath-hold in definitive non-small cell lung cancer radiotherapy.
abstract: The purpose of this study is to evaluate the effect of Active Breathing Control-moderate deep inspiration breath-hold (ABC-mDIBH) on tumor motion and critical organ doses in non-small cell lung cancer (NSCLC) radiotherapy. 23 patients with locally advanced NSCLC were included in the study. All patients were scanned at free breathing and ABC-mDIBH for radiation treatment planning. 3 separate treatment plans were generated for each patient including one plan with ABC-mDIBH and uniform margins, one plan with free breathing and uniform margins, and one plan with free breathing and 3-dimensional non-uniform margins determined by Cone Beam Computed Tomography (CBCT) and XVI Motion View (X-ray Volume Imaging, Elekta, UK). Critical organ dose-volumes and physical lung parameters were comparatively evaluated on 3 separate dose-volume histograms of each patient acquired from planning software. Individual tumor motion of each patient with and without ABC-mDIBH was documented and compared. Use of ABC-mDIBH resulted in statistically significant improvement in physical lung parameters of V20 (lung volume receiving ≥ 20 Gy) and mean lung dose (MLD) which are predictors of radiation pneumonitis (p<0.001). Reduction in spinal cord dose and tumor motion with ABC-mDIBH was also statistically significant (p<0.001). ABC-mDIBH increases normal lung tissue sparing in definitive NSCLC radiotherapy by improving physical lung parameters along with spinal cord dose reduction through exact tumor immobilization. The incorporation of ABC-mDIBH into NSCLC radiotherapy may have implications for potential margin reduction and dose escalation to improve treatment outcomes.
authors.affiliation: Department of Radiation Oncology, Gulhane Military Medical Academy, Ankara, Turkey. omersager@gmail.com
authors.forename: O
authors.initials: O
authors.lastname: Sager
authors.forename: M
authors.initials: M
authors.lastname: Beyzadeoglu
authors.forename: F
authors.initials: F
authors.lastname: Dincoglan
authors.forename: K
authors.initials: K
authors.lastname: Oysul
authors.forename: Y Elcim
authors.initials: YE
authors.lastname: Kahya
authors.forename: H
authors.initials: H
authors.lastname: Gamsiz
authors.forename: B
authors.initials: B
authors.lastname: Uysal
authors.forename: S
authors.initials: S
authors.lastname: Demiral
authors.forename: B
authors.initials: B
authors.lastname: Dirican
authors.forename: S
authors.initials: S
authors.lastname: Surenkok
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D000368:Aged; D001945:Breathing Exercises; D018287:Carcinoma, Large Cell / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D007103:Immobilization; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011880:Radiotherapy Planning, Computer-Assisted; D014057:Tomography, X-Ray Computed