Systematic review for deep inspiration breath hold in proton therapy for mediastinal lymphoma: A PTCOG Lymphoma Subcommittee report and recommendations.

Rahul R Parikh, Bradford Hoppe, Georgios Ntentas, Carola Lütgendorf-Caucig, Ester Orlandi, Pierre Loap, James E Bates, John P Plastaras, Laila Konig, Raymond Mailhot Vega, Youlia M Kirova, Pranshu Mohindra, Stella Flampouri, Deanna Pafundi, Scott Lester, Yolanda D Tseng, Marianne Aznar, Jennifer Peterson, Chirayu G Patel

Journal: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology 2022;177():21-32

PMID: 36252635

Full Text on Elsevier Science View on PubMed

Abstract

PURPOSE

To systematically review all dosimetric studies investigating the impact of deep inspiration breath hold (DIBH) compared with free breathing (FB) in mediastinal lymphoma patients treated with proton therapy as compared to IMRT (intensity-modulated radiation therapy)-DIBH.

MATERIALS AND METHODS

We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline using the PubMed database to identify studies of mediastinal lymphoma patients with dosimetric comparisons of proton-FB and/or proton-DIBH with IMRT-DIBH. Parameters included mean heart (MHD), lung (MLD), and breast (MBD) doses, among other parameters. Case reports were excluded. Absolute differences in mean doses > 1 Gy between comparators were considered to be clinically meaningful.

RESULTS

As of April 2021, eight studies fit these criteria (n = 8), with the following comparisons: proton-FB vs IMRT-DIBH (n = 5), proton-DIBH vs proton-FB (n = 5), and proton-DIBH vs IMRT-DIBH (n = 8). When comparing proton-FB with IMRT-DIBH in 5 studies, MHD was reduced with proton-FB in 2 studies, was similar (<1 Gy difference) in 2 studies, and increased in 1 study. On the other hand, MLD and MBD were reduced with proton-FB in 3 and 4 studies, respectively. When comparing proton-DIBH with proton-FB, MHD and MLD were reduced with proton DIBH in 4 and 3 studies, respectively, while MBD remained similar. Compared with IMRT-DIBH in 8 studies, proton-DIBH reduced the MHD in 7 studies and was similar in 1 study. Furthermore, MLD and MBD were reduced with proton-DIBH in 8 and 6 studies respectively. Integral dose was similar between proton-FB and proton-DIBH, and both were substantially lower than IMRT-DIBH.

CONCLUSION

Accounting for heart, lung, breast, and integral dose, proton therapy (FB or DIBH) was superior to IMRT-DIBH. Proton-DIBH can lower dose to the lungs and heart even further compared with proton-FB, depending on disease location in the mediastinum, and organ-sparing and target coverage priorities.

Address: Department of Radiation Oncology, Massachusetts General Hospital, Boston, USA. Electronic address: [email protected].; Radiation Oncology, Mayo Clinic, Rochester, USA.; University of Manchester, Division of Cancer Sciences, Manchester, United Kingdom.; Department of Radiation Oncology, University of Washington, Seattle, USA.; Mayo Clinic, Radiation Oncology, Jacksonville, USA.; Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, USA.; Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA.; Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, New Brunswick, NJ, USA.; Department of Radiation Oncology, University of Florida, Gainsville, Florida, USA.; Department of Radiation Oncology, Heidelberg University Hospital; Heidelberg Ion Beam Therapy Centre (HIT); National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany.; Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA.; Department of Radiation Oncology, Institut Curie, Paris, France.; National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy.; MedAustron Ion Therapy Center, Wiener Neustadt, Austria.; Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, Department of Medical Physics, London, United Kingdom.

DOI: 10.1016/j.radonc.2022.10.003

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MeSH Terms: Humans, Proton Therapy, Breath Holding, Organs at Risk, Radiotherapy Planning, Computer-Assisted, Protons, Mediastinal Neoplasms, Lymphoma, Heart, Radiotherapy Dosage, Unilateral Breast Neoplasms