Abstract
BackgroundRadiation therapy to upper abdominal sites is technically challenging due to motion of tumors and surrounding organs resulting from normal respiration. Breath-hold, using an Active Breathing Coordinator is one strategy used to reduce motion in these tumor sites. Though widely used, no studies have prospectively compared the different breath-hold techniques (inspiration, deep-inspiration and expiration) using ABC in the same patient cohort.MethodsPatients planned for radiation therapy to upper abdominal tumors are invited to participate in this prospective study. Participants attempt three breath hold techniques: inspiration, deep-inspiration and expiration breath-hold, in random order. kV fluoroscopy images of the dome of diaphragm are taken of five consecutive breath-holds in each technique. Reproducibility and stability of tumour position are measured, and used to select the technique with which to proceed to planning and treatment. Reproducibility at planning and each treatment fraction is measured, along with breath hold time, treatment efficiency and patient experience.DiscussionThe screening method was validated after the first three participants. This screening process may be able to select the best breath-hold technique for an individual, which may lead to improved reproducibility. The screening process is being piloted as a prospective clinical trial.Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR): 12618001691235. Registered 12th October 2018. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376109&isReview=true.
Highlights
Radiation therapy to upper abdominal sites is technically challenging due to motion of tumors and surrounding organs resulting from normal respiration
Radiation therapy (RT) to upper abdominal (UA) sites, including liver, pancreas, kidneys and adrenal glands, is technically challenging. This is due to the proximity of the tumor to organs at risk (OAR), and OAR motion due to both respiration and physiological variation, such as filling of gastro-intestinal organs [1]
Eligible participants are provided with written information about the study from their Radiation Oncologist (RO) or the study coordinator
Summary
Radiation therapy to upper abdominal sites is technically challenging due to motion of tumors and surrounding organs resulting from normal respiration. No studies have prospectively compared the different breath-hold techniques (inspiration, deep-inspiration and expiration) using ABC in the same patient cohort. Radiation therapy (RT) to upper abdominal (UA) sites, including liver, pancreas, kidneys and adrenal glands, is technically challenging. This is due to the proximity of the tumor to organs at risk (OAR), and OAR motion due to both respiration and physiological variation, such as filling of gastro-intestinal organs [1]. When an Active Breathing Coordinator (ABC)TM device (Elekta, Stockholm, Sweden) is used to assist breath-hold, improvements in RBH have been seen, with DIBH intra-fraction cohort RBH of 1.3–1.6 mm [6, Farrugia et al Radiat Oncol (2020) 15:250
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