PMID- 24359800
OWN - NLM
STAT- MEDLINE
DCOM- 20140715
LR  - 20211021
IS  - 1748-717X (Electronic)
IS  - 1748-717X (Linking)
VI  - 8
DP  - 2013 Dec 20
TI  - Reduced lung dose during radiotherapy for thoracic esophageal carcinoma: VMAT 
      combined with active breathing control for moderate DIBH.
PG  - 291
LID - 10.1186/1748-717X-8-291 [doi]
AB  - BACKGROUND: Lung radiation injury is a critical complication of radiotherapy (RT) 
      for thoracic esophageal carcinoma (EC). Therefore, the goal of this study was to 
      investigate the feasibility and dosimetric effects of reducing the lung tissue 
      irradiation dose during RT for thoracic EC by applying volumetric modulated arc 
      radiotherapy (VMAT) combined with active breathing control (ABC) for moderate 
      deep inspiration breath-hold (mDIBH). METHODS: Fifteen patients with thoracic EC 
      were randomly selected to undergo two series of computed tomography (CT) 
      simulation scans with ABC used to achieve mDIBH (representing 80% of peak DIBH 
      value) versus free breathing (FB). Gross tumor volumes were contoured on 
      different CT images, and planning target volumes (PTVs) were obtained using 
      different margins. For PTV-FB, intensity-modulated radiotherapy (IMRT) was 
      designed with seven fields, and VMAT included two whole arcs. For PTV-DIBH, VMAT 
      with three 135 degrees  arcs was applied, and the corresponding plans were named: 
      IMRT-FB, VMAT-FB, and VMAT-DIBH, respectively. Dosimetric differences between the 
      different plans were compared. RESULTS: The heart volumes decreased by 19.85%, 
      while total lung volume increased by 52.54% in mDIBH, compared to FB (p < 0.05). 
      The mean conformality index values and homogeneity index values for VMAT-DIBH 
      (0.86, 1.07) were slightly worse than those for IMRT-FB (0.90, 1.05) and VMAT-FB 
      (0.90, 1.06) (p > 0.05). Furthermore, compared to IMRT-FB and VMAT-FB, VMAT-DIBH 
      reduced the mean total lung dose by 18.64% and 17.84%, respectively (p < 0.05); 
      moreover, the V5, V10, V20, and V30 values for IMRT-FB and VMAT-FB were reduced 
      by 10.84% and 10.65% (p > 0.05), 12.5% and 20% (p < 0.05), 30.77% and 33.33% (p < 
      0.05), and 50.33% and 49.15% (p < 0.05), respectively. However, the heart 
      dose-volume indices were similar between VMAT-DIBH and VMAT-FB which were lower 
      than IMRT-FB without being statistically significant (p > 0.05). The monitor 
      units and treatment time of VMAT-DIBH were also the lowest (p < 0.05). 
      CONCLUSIONS: VMAT combined with ABC to achieve mDIBH is a feasible approach for 
      RT of thoracic EC. Furthermore, this method has the potential to effectively 
      reduce lung dose in a shorter treatment time and with better targeting accuracy.
FAU - Gong, Guanzhong
AU  - Gong G
FAU - Wang, Ruozheng
AU  - Wang R
FAU - Guo, Yujie
AU  - Guo Y
FAU - Zhai, Deyin
AU  - Zhai D
FAU - Liu, Tonghai
AU  - Liu T
FAU - Lu, Jie
AU  - Lu J
FAU - Chen, Jinhu
AU  - Chen J
FAU - Liu, Chengxin
AU  - Liu C
FAU - Yin, Yong
AU  - Yin Y
AD  - Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan 
      250117, China. yongyinsd@163.com.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20131220
PL  - England
TA  - Radiat Oncol
JT  - Radiation oncology (London, England)
JID - 101265111
SB  - IM
MH  - Adult
MH  - Aged
MH  - Esophageal Neoplasms/*radiotherapy
MH  - Female
MH  - Heart/physiology
MH  - Humans
MH  - Lung/physiology/*radiation effects
MH  - Male
MH  - Middle Aged
MH  - Movement
MH  - Organs at Risk
MH  - Radiometry/methods
MH  - Radiotherapy/methods
MH  - Radiotherapy Dosage
MH  - Radiotherapy Planning, Computer-Assisted/methods
MH  - Radiotherapy, Intensity-Modulated/*methods
MH  - Random Allocation
MH  - Reproducibility of Results
MH  - *Respiration
MH  - Thoracic Neoplasms/*radiotherapy
MH  - Tomography, X-Ray Computed
PMC - PMC3896728
EDAT- 2013/12/24 06:00
MHDA- 2014/07/16 06:00
PMCR- 2013/12/20
CRDT- 2013/12/24 06:00
PHST- 2013/07/16 00:00 [received]
PHST- 2013/12/08 00:00 [accepted]
PHST- 2013/12/24 06:00 [entrez]
PHST- 2013/12/24 06:00 [pubmed]
PHST- 2014/07/16 06:00 [medline]
PHST- 2013/12/20 00:00 [pmc-release]
AID - 1748-717X-8-291 [pii]
AID - 10.1186/1748-717X-8-291 [doi]
PST - epublish
SO  - Radiat Oncol. 2013 Dec 20;8:291. doi: 10.1186/1748-717X-8-291.