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Zhao F, Zhou ZY, Wang YQ, Jiang YT, Wang YXJ, Yu H, Yu HG, Bu LY, Lu ZJ, Yao GR, Yan SX. A Convenient and Effective Preoxygenation Technique for Prolonging Deep Inspiration Breath-Hold Duration With a Venturi Mask With a 50% Oxygen Concentration. Pract Radiat Oncol 2024; 14:e87-e96. [PMID: 37871850 DOI: 10.1016/j.prro.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/29/2023] [Accepted: 10/06/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE Voluntary deep inspiration breath-hold (DIBH) is commonly used in radiation therapy (RT), but the short duration of a single breath-hold, estimated to be around 20 to 40 seconds, is a limitation. This prospective study aimed to assess the feasibility and safety of using a simple preoxygenation technique with a Venturi mask to prolong voluntary DIBH. METHODS AND MATERIALS The study included 33 healthy volunteers and 21 RT patients. Preoxygenation was performed using a Venturi mask with a 50% oxygen concentration. Paired t tests compared the duration of a single DIBH in room air and after 5, 15, and 30 minutes of preoxygenation in healthy volunteers. Sustainability of breath-hold and tolerability of heart rate and blood pressure were assessed for multiple DIBH durations in both volunteers and patients. RESULTS In healthy volunteers, a 15-minute preoxygenation significantly prolonged the duration of a single DIBH by 24.95 seconds compared with 5-minute preoxygenation (89 ± 27.76 vs 113.95 ± 30.63 seconds; P < .001); although there was a statistically significant increase in DIBH duration after 30-minute preoxygenation, it was only extended by 4.95 seconds compared with 15-minute preoxygenation (113.95 ± 30.63 vs 118.9 ± 29.77 seconds; P < .01). After 15-minute preoxygenation, a single DIBH lasted over 100 seconds in healthy volunteers and over 80 seconds in RT patients, with no significant differences among 6 consecutive cycles of DIBH. Furthermore, there were no significant differences in heart rate or blood pressure after DIBHs, including DIBH in room air and 6 consecutive DIBHs after 15-minute preoxygenation (all P > .05). CONCLUSIONS Preoxygenation with a 50% oxygen concentration for 15 minutes effectively prolongs the duration of 6 cycles of DIBH both in healthy volunteers and RT patients. The utilization of a Venturi mask to deliver 50% oxygen concentration provides a solution characterized by its convenience, good tolerability, and effectiveness.
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Affiliation(s)
- Feng Zhao
- Department of Radiation Oncology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China; Cancer Center, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China.
| | - Zi-Yang Zhou
- Department of Radiation Oncology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China; Graduate School, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Yi-Qi Wang
- Department of Radiation Oncology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China; Graduate School, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Yan-Ting Jiang
- Department of Radiation Oncology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China; Graduate School, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Yi-Xiang J Wang
- Department of Imaging and Interventional Radiology, the Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Hao Yu
- Department of Radiation Oncology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China; Graduate School, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Hao-Gang Yu
- Department of Radiation Oncology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China; Cancer Center, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Lu-Yi Bu
- Department of Radiation Oncology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China; Cancer Center, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Zhong-Jie Lu
- Department of Radiation Oncology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China; Cancer Center, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Guo-Rong Yao
- Department of Radiation Oncology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China; Cancer Center, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China.
| | - Sen-Xiang Yan
- Department of Radiation Oncology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China; Cancer Center, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China.
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Zhang N, Liu X, Tao D, Wang Y, Wu Y, Zeng X. Optimal radiotherapy modality sparing for cardiac valves in left-sided breast cancer. ANNALS OF TRANSLATIONAL MEDICINE 2023; 11:46. [PMID: 36819565 PMCID: PMC9929844 DOI: 10.21037/atm-22-6633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 01/07/2023] [Indexed: 01/15/2023]
Abstract
Background The cardiotoxicity caused by radiotherapy is a critical problem in the treatment of patients with breast cancer. The appropriate radiotherapy modality sparing for cardiac valves in left-sided breast cancer has not been well defined. The aim of this study was thus to compare the dosimetric differences in heart and cardiac valves of 3-dimensional conformal radiotherapy (3D-CRT), fixed-field intensity-modulated radiation therapy (IMRT), and volumetric-modulated arc therapy (VMAT) to find the optimal radiotherapy modality sparing for cardiac valves in patients with left breast cancer. Methods From January 5, 2021, to March 15, 2021, 21 patients with left-sided breast cancer postmastectomy were included in this study, and 3 different plans for adjuvant radiation were created using 3D-CRT, IMRT, and VMAT for each patient. All patients received 50 Gy in 25 fractions. The mean dose (Dmean) of the heart; percentage volume of the heart receiving ≥5 Gy (V5), ≥30 Gy (V30), and ≥40 Gy (V40); and the Dmean and the near-maximum dose (D0.03cc) of cardiac valves were extracted from dose-volume histograms (DVHs) and compared. The correlations in dosimetric factors between cardiac valves and the whole heart were analyzed. Results IMRT significantly decreased the values of V5, V30, V40, and Dmean in the whole heart compared to 3D-CRT and VMAT (P<0.001). Among the 3 different plans, IMRT had the lowest radiation dose to the Dmean and the D0.03cc of the aortic valve (1.27 Gy/1.75 Gy), pulmonary valve (3.44 Gy/6.89 Gy), tricuspid valve (1.02 Gy/1.14 Gy), and mitral valve (0.93 Gy/1.00 Gy). Pearson correlation analysis found that local parameters (Dmean and D0.03cc) within valves were strongly correlated to the global parameters (V5, V30, V40, and Dmean) of the heart. Conclusions This study revealed that IMRT showed the lowest cardiac valves dose compared with 3D-CRT and VMAT in left-sided breast cancer radiotherapy. IMRT might be the optimal modality sparing for cardiac valves in this group of patients. Further studies need to be carried out in order to validate the protective role of IMRT on the cardiac valves.
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Affiliation(s)
- Ningning Zhang
- Department of Breast Cancer Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Xianfeng Liu
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Dan Tao
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, China;,Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
| | - Ying Wang
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, China;,Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
| | - Yongzhong Wu
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, China;,Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
| | - Xiaohua Zeng
- Department of Breast Cancer Center, Chongqing University Cancer Hospital, Chongqing, China
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Yan D, Ning L, Chen Y, Ke S, Huang H, Wang L, Yan S. Analysis of deep inspiration breath-hold technique to improve dosimetric and clinical advantages in postoperative intensity-modulated radiation therapy for thymomas. Quant Imaging Med Surg 2022; 12:4239-4247. [PMID: 35919039 PMCID: PMC9338384 DOI: 10.21037/qims-21-1101] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 04/28/2022] [Indexed: 11/10/2022]
Abstract
Background Radiation therapy is one of the essential treatment modalities for invasive thymomas. Clinically, respiratory motion poses a challenge for the radiotherapy of thoracic tumors. One method to address this issue is to train patients to hold their breath at the end of deep inspiration. The purpose of this retrospective cohort study was to investigate the dosimetric and clinical advantages of the deep inspiration breath-hold (DIBH) technique in postoperative intensity-modulated radiation therapy (IMRT) for thymomas. Methods Thymoma patients undergoing postoperative IMRT were included. Each patient underwent two computed tomography (CT) scans, one under free breath (FB) and the other under DIBH. Dosimetric parameters of organs at risk (OARs) were evaluated in three series plans. Dose analysis and volume comparisons were conducted during FB-3 mm (FB with 3 mm internal target volume margin), FB-10 mm (FB with 10 mm internal target volume margin), and DIBH and compared using a paired sample Student’s t-test. Normal tissue complication probabilities (NTCP) for lungs and heart were calculated and compared. Results The total lung volume significantly increased by 31% (4,216±198 vs. 2,884±166 mL) and the heart volume reduced by 12% (552±25 vs. 636±35 mL) between DIBH acquisitions compared to FB. A significant improvement was observed in all the dosimetric parameters (Dmean, V20, V5) of the lung on DIBH compared to FB-3 mm (54%±2.85% vs. 47%±2.90%, P<0.001; 15%±1.37% vs. 12%±1.32%, P=0.004; and 10.28±0.58 vs. 8.76±0.57 Gy, P<0.001, respectively), as well as in the Dmax and D2% of the esophagus and spine. The lung volume increment was related to a reduction in the mean dose of lungs, with a correlation coefficient of r=0.27, P=0.03. The NTCP values for pneumonitis significantly reduced with DIBH compared to the FB state (0.6% vs. 1.1%, P<0.001). Conclusions The radiation dose to the OARs can be significantly reduced by using the DIBH technique in postoperative IMRT for thymomas. The increased volume of lungs using DIBH acquisitions can significantly reduce the incidence of pneumonitis.
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Affiliation(s)
- Danfang Yan
- Department of Radiation Oncology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Lihua Ning
- Department of Radiation Oncology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Ying Chen
- Department of Radiation Oncology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Shanbao Ke
- Cancer Center, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Huijie Huang
- Department of Radiation Oncology, Yili Friendship Hospital, Xinjiang, China
| | - Lihong Wang
- Department of Radiation Oncology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Senxiang Yan
- Department of Radiation Oncology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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