基于表面的深度吸气屏气放疗治疗左侧乳腺癌:SAVE-HEART研究的最终结果

IF 7.1 2区 医学 Q1 ONCOLOGY
ESMO Open Pub Date : 2024-12-01 Epub Date: 2024-12-03 DOI:10.1016/j.esmoop.2024.103993
S Schönecker, L Angelini, A Gaasch, A Zinn, D Konnerth, C Heinz, Y Xiong, K Unger, G Landry, I Meattini, M Braun, M Pölcher, N Harbeck, R Würstlein, M Niyazi, C Belka, M Pazos, S Corradini
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引用次数: 0

摘要

背景:辅助放疗(RT)在早期乳腺癌(BC)的治疗中起着至关重要的作用,但可能导致心血管和肺部毒性。深吸气屏气(DIBH)中的RT通常可以更好地保护处于危险中的器官。这项前瞻性研究通过评估个体心血管风险和治疗计划剂量学,比较了左侧BC患者表面引导DIBH和自由呼吸(FB)。患者和方法:该研究于2016年10月至2021年1月招募了585例左侧浸润性乳腺癌患者,伴有或不伴有区域淋巴结的乳腺/胸壁指示性辅助RT。能在20多岁时屏住呼吸是一个先决条件。治疗方法为低分割(HF);40.05 Gy/15Fx)或正分馏(NF;50.00 Gy / 25外汇)。DIBH采用带有音视频反馈的自动触发水面制导系统Catalyst。在DIBH和FB期间获得了计算机断层扫描和表面数据。该研究的主要终点是使用DIBH降低心脏剂量的比较评价。结果:DIBH对计划剂量学有明显改善。HF和NF组心脏和左冠状动脉的平均和最大剂量显著降低36% ~ 42% (P < 0.001),而同侧肺的平均剂量降低12% ~ 14% (P < 0.001)。此外,与FB相比,DIBH导致累积10年心血管疾病风险(10年心血管疾病风险)降低5%(3.59%至3.41%;P < 0.001)。结论:据我们所知,这是最大的前瞻性研究,显示与FB相比,表面引导DIBH对左侧BC患者的心脏和同侧肺剂量有更好的节省。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Surface-based deep inspiration breath-hold radiotherapy in left-sided breast cancer: final results from the SAVE-HEART study.

Background: Adjuvant radiotherapy (RT) plays an essential role in the management of early breast cancer (BC), but can lead to cardiovascular and lung toxicities. RT in deep inspiration breath hold (DIBH) often allows better protection of organs at risk. This prospective study compares surface-guided DIBH with free breathing (FB) in patients with left-sided BC, by evaluating individual cardiovascular risks and treatment plan dosimetry.

Patients and methods: The study enrolled 585 patients from October 2016 to January 2021 with left-sided invasive breast carcinoma with indicated adjuvant RT of the breast/thoracic wall with or without regional lymph nodes. The ability to hold breath for 20 s was a prerequisite. The treatments were either hypofractionated (HF; 40.05 Gy/15Fx) or normofractionated (NF; 50.00 Gy/25Fx). DIBH was applied using the automatically triggered surface guidance system Catalyst with audio-video feedback. Computed tomography and surface data were acquired during both DIBH and FB. The primary endpoint of the study was the comparative evaluation of heart dose reduction using DIBH.

Results: Plan dosimetry was significantly improved by DIBH. The mean and maximum doses to the heart and the left coronary artery were significantly reduced by 36%-42% in HF and NF plans (P < 0.001), while the mean ipsilateral lung dose was reduced by 12%-14% (P < 0.001). Furthermore, DIBH resulted in a 5% reduction in the cumulative 10-year cardiovascular disease risk (10-year cardiovascular disease risk) compared with FB (3.59% to 3.41%; P < 0.001).

Conclusion: To the best of our knowledge, this is the largest prospective study showing better sparing for cardiac and ipsilateral lung doses with surface-guided DIBH compared with FB in patients with left-sided BC.

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来源期刊
ESMO Open
ESMO Open Medicine-Oncology
CiteScore
11.70
自引率
2.70%
发文量
255
审稿时长
10 weeks
期刊介绍: ESMO Open is the online-only, open access journal of the European Society for Medical Oncology (ESMO). It is a peer-reviewed publication dedicated to sharing high-quality medical research and educational materials from various fields of oncology. The journal specifically focuses on showcasing innovative clinical and translational cancer research. ESMO Open aims to publish a wide range of research articles covering all aspects of oncology, including experimental studies, translational research, diagnostic advancements, and therapeutic approaches. The content of the journal includes original research articles, insightful reviews, thought-provoking editorials, and correspondence. Moreover, the journal warmly welcomes the submission of phase I trials and meta-analyses. It also showcases reviews from significant ESMO conferences and meetings, as well as publishes important position statements on behalf of ESMO. Overall, ESMO Open offers a platform for scientists, clinicians, and researchers in the field of oncology to share their valuable insights and contribute to advancing the understanding and treatment of cancer. The journal serves as a source of up-to-date information and fosters collaboration within the oncology community.
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