Protocol of a study investigating breath-hold techniques for upper-abdominal radiation therapy (BURDIE): addressing the
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Protocol of a study investigating breath‑hold techniques for upper‑abdominal radiation therapy (BURDIE): addressing the challenge of a moving target Briana Farrugia1,2* , Richard Khor1, Farshad Foroudi1, Michael Chao1, Kellie Knight2 and Caroline Wright2
Abstract Background: Radiation 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. Methods: Patients 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 breathhold, 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. Discussion: The 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. Keywords: Breath holding, Neoplasms, Radiotherapy Background 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]. *Correspondence: [email protected] 1 Radiation Oncology, Olivia Newton‑John Cancer Wellness and Research Centre, Austin Health, PO Box 5555, Heidelberg, VIC 3084, Australia Full list of author information is available at the end of the article
Breath-hold (BH) techniques, either voluntary or assisted, have been implemented to minimize respiratory-induced motion [2–7]. Inspiration Breath-Hold (IBH), Deep-Inspiration Breath-Hold (DIBH) and Expiration Breath-Hold (EBH) are reported in the literature [3–7]. Employing a voluntary IBH technique has demonstrated cohort reproducibility (RBH) of 4–10 mm [3, 8, 9], whilst voluntary EBH has demonstrated cohort RBH of 2–5 mm [3, 9]. When an Active Breathing Coordinator (ABC)™ device (Elekta, Stockholm, Sw
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