Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Assessment of Physical Lung Dose-Volume Parameters in Patients Receiving Split Course Radiation Therapy for Advanced-Stage Non Small Cell Lung Cancer: Dosimetric Effect of Active Breathing Control and Clinical Implications: Analytical Research, Case-Control
İleri Küçük Hücreli Olmayan Akciğer Kanserinde Split Kurs Radyasyon Tedavisi Alan Hastalarda Fiziksel Akciğer Doz-Hacim Parametrelerinin Değerlendirilmesi: Analitik Araştırma, Vaka-Kontrol
Esin GÜNDEMa, Yelda ELÇİMa
aDepartment of Radiation Oncology, Gülhane Training and Research Hospital University of Health Sciences, Gülhane Medical Faculty, Ankara, Türkiye
Turkiye Klinikleri J Med Sci. 2022;42(4):275-81
doi: 10.5336/medsci.2022-90110
Article Language: EN
Full Text
ABSTRACT
 Objective: Active breathing control (ABC) system serves as a viable technique for the management of respiratory motion by providing reproducible breath-holding. Herein, we assess physical lung dose-volume parameters of V20 (total lung volume receiving ≥20 Gy) and mean total lung dose (MLD) in a series of patients receiving split course radiation therapy (SCRT) for advanced-stage non-small cell lung cancer (NSCLC) with the incorporation of the ABC system. Material and Methods: A series of 22 patients receiving ABC-guided SCRT for advanced-stage NSCLC were evaluated for physical lung dose-volume parameters of V20 and MLD. Two different radiation therapy plans have been generated for every patient with and without the incorporation of the ABC system to investigate the dosimetric impact. Results: Mean V20 and MLD were 32.3% and 2,104 cGy, respectively at freebreathing. Mean V20 and MLD were 24.7% and 1,697 cGy, respectively with the incorporation of the ABC system. The decrease in V20 and MLD was 23.53% and 19.34%, respectively. Conclusion: Our study shows improved normal lung tissue sparing by incorporation of ABC system in SCRT of advanced-stage NSCLC. The reduction in V20 and MLD may have clinical implications. Improved normal lung tissue sparing by use of the ABC system may result in an improved toxicity profile of radiation delivery and thereby enable dose escalation in selected patients. Admittedly, clinical follow-up of patients should be performed to elucidate clinical reflections of dosimetric gains achieved by the ABC system.

Keywords: Advanced-stage non-small cell lung cancer; split course radiation therapy; active breathing control
ÖZET
 Amaç: Aktif solunum kontrolü (ABC) sistemi, tekrarlanabilir nefes tutmayı sağlayarak solunum hareketinin yönetimi için uygun bir teknik olarak görev yapar. Burada, ileri evre küçük hücreli dışı akciğer kanseri (KHDAK) için split kurs radyasyon tedavisi [split course radiation therapy (SCRT)] alan bir dizi hastada V20'nin (≥20 Gy alan total akciğer hacmi) ve ortalama total akciğer dozunun [mean total lung dose (MLD)] fiziksel akciğer dozu-hacim parametreleri, ABC sistemi dâhil edilerek değerlendirilmiştir. Gereç ve Yöntemler: İlerlemiş KHDAK için ABC kılavuzlu SCRT uygulanan 22 hastada, fiziksel akciğer dozhacim parametreleri olan V20 ve MLD değerleri karşılaştırılmıştır. Dozimetrik etkiyi araştırmak için her hasta için, ABC sistemi dâhil olan ve olmayan 2 farklı radyasyon tedavisi planı oluşturulmuştur. Bulgular: Serbest solunumda ortalama V20 ve MLD sırasıyla %32,3 ve 2,104 cGy idi. ABC sisteminin dâhil edilmesiyle ortalama V20 ve MLD, sırasıyla %24,7 ve 1,697 cGy olmuştur. V20 ve MLD'deki düşüş sırasıyla %23,53 ve %19,34 olarak bulunmuştur. Sonuç: Çalışmamız, ileri evre KHDAK'nin SCRT tedavisine ABC sisteminin dâhil edilmesiyle normal akciğer dokusunun daha iyi korunduğunu göstermektedir. V20 ve MLD'deki azalmanın klinik sonuçlara etkisi olabilir. ABC sisteminin kullanılması, normal akciğer doku korumasında artış, radyoterapiye bağlı toksisite profilinde iyileşme ve seçilmiş hastalarda doz eskalasyonu ile sonuçlanabilir. ABC sisteminin sağladığı dozimetrik kazanımların kliniğe yansımalarını aydınlatmak için hastaların klinik takibi mutlaka yapılmalıdır.

Anahtar Kelimeler: İleri evre küçük hücreli olmayan akciğer kanseri; split kurs radyasyon tedavisi; aktif solunum kontrolü
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