Comparison of Deep Inspiration Breath Hold and Free Breathing Intensity Modulated Proton Therapy of Locally Advanced Lung Cancer

Overview

Journal Phys Imaging Radiat Oncol

Specialty Oncology

Date 2024 Jun 3

PMID 38827886

Authors

Kristine Fjellanger

Ben J M Heijmen

Sebastiaan Breedveld

Inger Marie Sandvik

Liv B Hysing

Affiliations

Soon will be listed here.

Abstract

Background And Purpose: For locally advanced non-small cell lung cancer (LA-NSCLC), intensity-modulated proton therapy (IMPT) can reduce organ at risk (OAR) doses compared to intensity-modulated radiotherapy (IMRT). Deep inspiration breath hold (DIBH) reduces OAR doses compared to free breathing (FB) in IMRT. In IMPT, differences in dose distributions and robustness between DIBH and FB are unclear. In this study, we compare DIBH to FB in IMPT, and IMPT to IMRT.

Materials And Methods: Fortyone LA-NSCLC patients were prospectively included. 4D computed tomography images (4DCTs) and DIBH CTs were acquired for treatment planning and during weeks 1 and 3 of treatment. A new system for automated robust planning was developed and used to generate a FB and a DIBH IMPT plan for each patient. Plans were compared in terms of dose-volume parameters and normal tissue complication probabilities (NTCPs). Dose recalculations on repeat CTs were used to compare inter-fraction plan robustness.

Results: In IMPT, DIBH reduced median lungs D from 9.3 Gy(RBE) to 8.0 Gy(RBE) compared to FB, and radiation pneumonitis NTCP from 10.9 % to 9.4 % ( < 0.001). Inter-fraction plan robustness for DIBH and FB was similar. Median NTCPs for radiation pneumonitis and mortality were around 9 percentage points lower with IMPT than IMRT ( < 0.001). These differences were much larger than between FB and DIBH within each modality.

Conclusion: DIBH IMPT resulted in reduced lung dose and radiation pneumonitis NTCP compared to FB IMPT. Inter-fraction robustness was comparable. OAR doses were far lower in IMPT than IMRT.

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References

Zou Z, Bowen S, Thomas H, Sasidharan B, Rengan R, Zeng J . Scanning Beam Proton Therapy versus Photon IMRT for Stage III Lung Cancer: Comparison of Dosimetry, Toxicity, and Outcomes. Adv Radiat Oncol. 2020; 5(3):434-443. PMC: 7276696. DOI: 10.1016/j.adro.2020.03.001. View

Jin J, Hu C, Xiao Y, Zhang H, Paulus R, Ellsworth S . Higher Radiation Dose to the Immune Cells Correlates with Worse Tumor Control and Overall Survival in Patients with Stage III NSCLC: A Secondary Analysis of RTOG0617. Cancers (Basel). 2021; 13(24. PMC: 8699524. DOI: 10.3390/cancers13246193. View

Fredriksson A, Forsgren A, Hardemark B . Minimax optimization for handling range and setup uncertainties in proton therapy. Med Phys. 2011; 38(3):1672-84. DOI: 10.1118/1.3556559. View

Marchand V, Zefkili S, Desrousseaux J, Simon L, Dauphinot C, Giraud P . Dosimetric comparison of free-breathing and deep inspiration breath-hold radiotherapy for lung cancer. Strahlenther Onkol. 2012; 188(7):582-9. DOI: 10.1007/s00066-012-0129-9. View

Li Y, Kardar L, Li X, Li H, Cao W, Chang J . On the interplay effects with proton scanning beams in stage III lung cancer. Med Phys. 2014; 41(2):021721. PMC: 4108709. DOI: 10.1118/1.4862076. View

Hansen C, Crijns W, Hussein M, Rossi L, Gallego P, Verbakel W . Radiotherapy Treatment plannINg study Guidelines (RATING): A framework for setting up and reporting on scientific treatment planning studies. Radiother Oncol. 2020; 153:67-78. DOI: 10.1016/j.radonc.2020.09.033. View

Josipovic M, Aznar M, Thomsen J, Scherman J, Damkjaer S, Nygard L . Deep inspiration breath hold in locally advanced lung cancer radiotherapy: validation of intrafractional geometric uncertainties in the INHALE trial. Br J Radiol. 2019; 92(1104):20190569. PMC: 6913352. DOI: 10.1259/bjr.20190569. View

Hoffmann L, Alber M, Jensen M, Holt M, Moller D . Adaptation is mandatory for intensity modulated proton therapy of advanced lung cancer to ensure target coverage. Radiother Oncol. 2017; 122(3):400-405. DOI: 10.1016/j.radonc.2016.12.018. View

Appelt A, Vogelius I, Farr K, Khalil A, Bentzen S . Towards individualized dose constraints: Adjusting the QUANTEC radiation pneumonitis model for clinical risk factors. Acta Oncol. 2013; 53(5):605-12. DOI: 10.3109/0284186X.2013.820341. View

10.

Fjellanger K, Hysing L, Heijmen B, Pettersen H, Sandvik I, Sulen T . Enhancing Radiotherapy for Locally Advanced Non-Small Cell Lung Cancer Patients with iCE, a Novel System for Automated Multi-Criterial Treatment Planning Including Beam Angle Optimization. Cancers (Basel). 2021; 13(22). PMC: 8616198. DOI: 10.3390/cancers13225683. View

11.

Liao Z, Lee J, Komaki R, Gomez D, OReilly M, Fossella F . Bayesian Adaptive Randomization Trial of Passive Scattering Proton Therapy and Intensity-Modulated Photon Radiotherapy for Locally Advanced Non-Small-Cell Lung Cancer. J Clin Oncol. 2018; 36(18):1813-1822. PMC: 6008104. DOI: 10.1200/JCO.2017.74.0720. View

12.

Fjellanger K, Rossi L, Heijmen B, Pettersen H, Sandvik I, Breedveld S . Patient selection, inter-fraction plan robustness and reduction of toxicity risk with deep inspiration breath hold in intensity-modulated radiotherapy of locally advanced non-small cell lung cancer. Front Oncol. 2022; 12:966134. PMC: 9469652. DOI: 10.3389/fonc.2022.966134. View

13.

Mah D, Yorke E, Zemanaj E, Han Z, Liu H, George J . A Planning Comparison of IMRT vs. Pencil Beam Scanning for Deep Inspiration Breath Hold Lung Cancers. Med Dosim. 2021; 47(1):26-31. PMC: 9423111. DOI: 10.1016/j.meddos.2021.07.003. View

14.

Persson G, Rydhog J, Josipovic M, Maraldo M, Nygard L, Costa J . Deep inspiration breath-hold volumetric modulated arc radiotherapy decreases dose to mediastinal structures in locally advanced lung cancer. Acta Oncol. 2016; 55(8):1053-6. DOI: 10.3109/0284186X.2016.1142115. View

15.

Gorgisyan J, Munck Af Rosenschold P, Perrin R, Persson G, Josipovic M, Belosi M . Feasibility of Pencil Beam Scanned Intensity Modulated Proton Therapy in Breath-hold for Locally Advanced Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys. 2017; 99(5):1121-1128. DOI: 10.1016/j.ijrobp.2017.08.023. View

16.

Chang J, Zhang X, Knopf A, Li H, Mori S, Dong L . Consensus Guidelines for Implementing Pencil-Beam Scanning Proton Therapy for Thoracic Malignancies on Behalf of the PTCOG Thoracic and Lymphoma Subcommittee. Int J Radiat Oncol Biol Phys. 2017; 99(1):41-50. DOI: 10.1016/j.ijrobp.2017.05.014. View

17.

Defraene G, Dankers F, Price G, Schuit E, van Elmpt W, Arredouani S . Multifactorial risk factors for mortality after chemotherapy and radiotherapy for non-small cell lung cancer. Radiother Oncol. 2019; 152:117-125. DOI: 10.1016/j.radonc.2019.09.005. View

18.

Spigel D, Faivre-Finn C, Gray J, Vicente D, Planchard D, Paz-Ares L . Five-Year Survival Outcomes From the PACIFIC Trial: Durvalumab After Chemoradiotherapy in Stage III Non-Small-Cell Lung Cancer. J Clin Oncol. 2022; 40(12):1301-1311. PMC: 9015199. DOI: 10.1200/JCO.21.01308. View

19.

Remon J, Soria J, Peters S . Early and locally advanced non-small-cell lung cancer: an update of the ESMO Clinical Practice Guidelines focusing on diagnosis, staging, systemic and local therapy. Ann Oncol. 2021; 32(12):1637-1642. DOI: 10.1016/j.annonc.2021.08.1994. View

20.

Gjyshi O, Xu T, Elhammali A, Boyce-Fappiano D, Chun S, Gandhi S . Toxicity and Survival After Intensity-Modulated Proton Therapy Versus Passive Scattering Proton Therapy for NSCLC. J Thorac Oncol. 2020; 16(2):269-277. PMC: 7855203. DOI: 10.1016/j.jtho.2020.10.013. View