TROG 14.04: Multicentre Study of Feasibility and Impact on Anxiety of DIBH in Breast Cancer Patients

Kron, T; Bressel, M; Lonski, P; Hill, C; Mercieca-Bebber, R; Ahern, V; Lehman, M; Johnson, C; Latty, D; Ward, R; Miller, D; Banjade, D; Morriss, D; De Abreu Lourenco, R; Woodcock, J; Montgomery, R; Lehmann, J; Chua, BH

Author(s): Kron, T; Bressel, M; Lonski, P; Hill, C; Mercieca-Bebber, R; Ahern, V; Lehman, M; Johnson, C; Latty, D; Ward, R; Miller, D; Banjade, D; Morriss, D; De Abreu Lourenco, R; Woodcock, J; Montgomery, R; Lehmann, J; Chua, BH;
Details: Publication Year 2022-09,Volume 34,Issue #9,Page e410-e419
Journal Title: Clinical Oncology
Publication Type: Research article
Abstract: AIMS: The aim of TROG 14.04 was to assess the feasibility of deep inspiration breath hold (DIBH) and its impact on radiation dose to the heart in patients with left-sided breast cancer undergoing radiotherapy. Secondary end points pertained to patient anxiety and cost of delivering a DIBH programme. MATERIALS AND METHODS: The study comprised two groups - left-sided breast cancer patients engaging DIBH and right-sided breast cancer patients using free breathing through radiotherapy. The primary end point was the feasibility of DIBH, defined as left-sided breast cancer patients' ability to breath hold for 15 s, decrease in heart dose in DIBH compared with the free breathing treatment plan and reproducibility of radiotherapy delivery using mid-lung distance (MLD) assessed on electronic portal imaging as the surrogate. The time required for treatment delivery, patient-reported outcomes and resource requirement were compared between the groups. RESULTS: Between February and November 2018, 32 left-sided and 30 right-sided breast cancer patients from six radiotherapy centres were enrolled. Two left-sided breast cancer patients did not undergo DIBH (one treated in free breathing as per investigator choice, one withdrawn). The mean heart dose was reduced from 2.8 Gy (free breathing) to 1.5 Gy (DIBH). Set-up reproducibility in the first week of treatment assessed by MLD was 1.88 +/- 1.04 mm (average +/- 1 standard deviation) for DIBH and 1.59 +/- 0.93 mm for free breathing patients. Using a reproducibility cut-off for MLD of 2 mm (1 standard deviation) as per study protocol, DIBH was feasible for 67% of DIBH patients. Radiotherapy delivery using DIBH took about 2 min longer than for free breathing. Anxiety was not significantly different in DIBH patients and decreased over the course of treatment in both groups. CONCLUSION: Although DIBH was shown to require about 2 min longer per treatment slot, it has the potential to reduce heart dose in left-sided breast cancer patients by nearly a half, provided careful assessment of breath hold reproducibility is carried out.
Publisher: Elsevier
Keywords: *Breast Neoplasms/radiotherapy; Breath Holding; Feasibility Studies; Female; Heart; Humans; Organs at Risk; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted/methods; Reproducibility of Results; *Unilateral Breast Neoplasms/radiotherapy; Anxiety; breast cancer radiotherapy; cardiac dose; deep inspiration breath hold
Department(s): Physical Sciences; Biostatistics and Clinical Trials
PubMed ID: 35717318
Publisher's Version: https://doi.org/10.1016/j.clon.2022.05.020
Terms of Use/Rights Notice: Refer to copyright notice on published article.

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Last Modified: 2024-12-20 06:39:29