PMID- 10524412
OWN - NLM
STAT- MEDLINE
DCOM- 19991027
LR  - 20220410
IS  - 0360-3016 (Print)
IS  - 0360-3016 (Linking)
VI  - 45
IP  - 3
DP  - 1999 Oct 1
TI  - Deep inspiration breath-hold technique for lung tumors: the potential value of 
      target immobilization and reduced lung density in dose escalation.
PG  - 603-11
AB  - 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.
FAU - Hanley, J
AU  - Hanley J
AD  - Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, 
      NY 10021, USA. HarleyJ@mskcc.org
FAU - Debois, M M
AU  - Debois MM
FAU - Mah, D
AU  - Mah D
FAU - Mageras, G S
AU  - Mageras GS
FAU - Raben, A
AU  - Raben A
FAU - Rosenzweig, K
AU  - Rosenzweig K
FAU - Mychalczak, B
AU  - Mychalczak B
FAU - Schwartz, L H
AU  - Schwartz LH
FAU - Gloeggler, P J
AU  - Gloeggler PJ
FAU - Lutz, W
AU  - Lutz W
FAU - Ling, C C
AU  - Ling CC
FAU - Leibel, S A
AU  - Leibel SA
FAU - Fuks, Z
AU  - Fuks Z
FAU - Kutcher, G J
AU  - Kutcher GJ
LA  - eng
GR  - P01-CA-59017/CA/NCI NIH HHS/United States
PT  - Journal Article
PT  - Research Support, U.S. Gov't, P.H.S.
PL  - United States
TA  - Int J Radiat Oncol Biol Phys
JT  - International journal of radiation oncology, biology, physics
JID - 7603616
SB  - IM
MH  - Aged
MH  - Carcinoma, Non-Small-Cell Lung/diagnostic imaging/pathology/*radiotherapy
MH  - Feasibility Studies
MH  - Female
MH  - Humans
MH  - Immobilization
MH  - *Inhalation
MH  - *Lung
MH  - Lung Neoplasms/diagnostic imaging/pathology/*radiotherapy
MH  - Male
MH  - Middle Aged
MH  - Radiation Dosage
MH  - Spirometry
MH  - Tomography, X-Ray Computed
EDAT- 1999/10/19 00:00
MHDA- 1999/10/19 00:01
CRDT- 1999/10/19 00:00
PHST- 1999/10/19 00:00 [pubmed]
PHST- 1999/10/19 00:01 [medline]
PHST- 1999/10/19 00:00 [entrez]
AID - S0360-3016(99)00154-6 [pii]
AID - 10.1016/s0360-3016(99)00154-6 [doi]
PST - ppublish
SO  - Int J Radiat Oncol Biol Phys. 1999 Oct 1;45(3):603-11. doi: 
      10.1016/s0360-3016(99)00154-6.