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

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

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Publisher:: Elsevier
Publication Type:: Journal Article
Citation:: Clinical Oncology, 2022, 34, (9), pp. e410-e419
Issue Date:: 2022-09

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Field	Value	Language
dc.contributor.author	Kron, T
dc.contributor.author	Bressel, M
dc.contributor.author	Lonski, P
dc.contributor.author	Hill, C
dc.contributor.author	Mercieca-Bebber, R
dc.contributor.author	Ahern, V
dc.contributor.author	Lehman, M
dc.contributor.author	Johnson, C
dc.contributor.author	Latty, D
dc.contributor.author	Ward, R
dc.contributor.author	Miller, D
dc.contributor.author	Banjade, D
dc.contributor.author	Morriss, D
dc.contributor.author	De Abreu Lourenco, R https://orcid.org/0000-0002-5978-8774
dc.contributor.author	Woodcock, J
dc.contributor.author	Montgomery, R
dc.contributor.author	Lehmann, J
dc.contributor.author	Chua, BH
dc.date.accessioned	2022-11-03T04:29:43Z
dc.date.available	2022-05-27
dc.date.available	2022-11-03T04:29:43Z
dc.date.issued	2022-09
dc.identifier.citation	Clinical Oncology, 2022, 34, (9), pp. e410-e419
dc.identifier.issn	0936-6555
dc.identifier.issn	1433-2981
dc.identifier.uri	http://hdl.handle.net/10453/163187
dc.description.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.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	Elsevier
dc.relation.ispartof	Clinical Oncology
dc.relation.isbasedon	10.1016/j.clon.2022.05.020
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	1112 Oncology and Carcinogenesis
dc.subject.classification	Oncology & Carcinogenesis
dc.subject.classification	Veterinary Sciences
dc.subject.mesh	Breast Neoplasms
dc.subject.mesh	Breath Holding
dc.subject.mesh	Feasibility Studies
dc.subject.mesh	Female
dc.subject.mesh	Heart
dc.subject.mesh	Humans
dc.subject.mesh	Organs at Risk
dc.subject.mesh	Radiotherapy Dosage
dc.subject.mesh	Radiotherapy Planning, Computer-Assisted
dc.subject.mesh	Reproducibility of Results
dc.subject.mesh	Unilateral Breast Neoplasms
dc.subject.mesh	Breast Neoplasms
dc.subject.mesh	Breath Holding
dc.subject.mesh	Feasibility Studies
dc.subject.mesh	Female
dc.subject.mesh	Heart
dc.subject.mesh	Humans
dc.subject.mesh	Organs at Risk
dc.subject.mesh	Radiotherapy Dosage
dc.subject.mesh	Radiotherapy Planning, Computer-Assisted
dc.subject.mesh	Reproducibility of Results
dc.subject.mesh	Unilateral Breast Neoplasms
dc.subject.mesh	Heart
dc.subject.mesh	Humans
dc.subject.mesh	Breast Neoplasms
dc.subject.mesh	Radiotherapy Dosage
dc.subject.mesh	Radiotherapy Planning, Computer-Assisted
dc.subject.mesh	Feasibility Studies
dc.subject.mesh	Reproducibility of Results
dc.subject.mesh	Female
dc.subject.mesh	Organs at Risk
dc.subject.mesh	Breath Holding
dc.subject.mesh	Unilateral Breast Neoplasms
dc.title	TROG 14.04: Multicentre Study of Feasibility and Impact on Anxiety of DIBH in Breast Cancer Patients.
dc.type	Journal Article
utslib.citation.volume	34
utslib.location.activity	England
utslib.for	1112 Oncology and Carcinogenesis
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Strength - CHERE - Centre for Health Economics Research and Evaluation
pubs.organisational-group	/University of Technology Sydney/Strength - CHT - Health Technologies
pubs.organisational-group	/University of Technology Sydney/Centre for Health Technologies (CHT)
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Centre for Health Economics Research and Evaluation
utslib.copyright.status	closed_access	*
pubs.consider-herdc	false
dc.date.updated	2022-11-03T04:29:42Z
pubs.issue	9
pubs.publication-status	Published
pubs.volume	34
utslib.citation.issue	9

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.

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http://hdl.handle.net/10453/163187