5 Jahre Erfahrung mit DIBH (Deep Inspiration Breath-Hold) kombiniert mit SGRT (Surface-Guided Radiation Therapy) bei linksseitigem Brustkrebs

Zusammenfassung

Hintergrund Die Radiatio bei Patienten mit einem linksseitigen Mammakarzinom ist mit einer erhöhten kardialen Mortalität und Morbidität vergesellschaftet. Die DIBH-Technik (Deep Inspiration Breath-Hold) in Kombination mit SGRT (Surface Guided Radiation Therapy, Catalyst-System) könnte deutliche dosimetrische Vorteile für Herz, LAD und die ipsilaterale Lunge gegenüber einer Bestrahlung in normaler Atmung haben. Deshalb wurde diese Technik im Oktober 2013 am Institut für Radioonkologie des KFJ/SMZ-Süd Wien eingeführt und klinisch implementiert.

Material und Methoden Von Oktober 2013 bis Dezember 2018 wurden 548 Patienten nach konservativer Operation von linksseitigem invasivem Brustkrebs zur Strahlentherapie überwiesen. Alle Patienten gaben ihr schriftliches Einverständnis und erhielten unabhängig vom Alter oder respiratorischen Erkrankungen Trainingseinheiten für die DIBH-Technik. Bei Nichtgelingen erfolgte die Planung in normaler Atemlage (NB). Verglichen wurde die relative Dosisreduktion am Herzen und der ipsiplateralen Lunge. Akute Nebenwirkungen wurden gemäß RTOG, Spätreaktionen nach CTCAE Version 4.03 ausgewertet.

Ergebnisse Das Durchschnittsalter der DIBH-Patienten betrug 58 Jahre (27–90a), der NB-Patienten 65 Jahre (30–80a). Die Nachsorge wurde bis Juni 2019 durchgeführt. Das mediane Follow-up betrug 52 Monate (Range 7–73 m). Ausgewertet wurden die mittleren Dosen (Dmean) für die Risikoorgane linke Lunge und Herz. Die Werte des Dmean an der linken Lunge lagen bei DIBH-Technik im Median bei 6,91 Gy (Range 1,44–12,4 Gy), am Herzen im Median bei 1,17 Gy (0,12–3,19 Gy). Bei den NB (normal breathing, free breathing)-Plänen lagen die Dmean-Werte der ipsilateralen Lunge bei 8,92 Gy (5,23–16,9 Gy), am Herzen bei 2,31 Gy (0,71–4,21 Gy), was einer Reduktion um die Hälfte entspricht. Die Akutreaktionen waren vergleichbar: RTOG 1: 70,8 % vs. 64 %, RTOG 3 6,6 % vs. 5,6 %, no reaction 3,2 % vs. 1,4 %. Bei den CTCAE1-NW gab es deutlich mehr Spätrektionen in der NB-Gruppe (51,6 % vs. 12,67 %).

Schlussfolgerung Die Deep-Inspiration-Breath-Hold (DIBH)-Technik mit Surface Guided Radiation Therapy (SGRT) ist eine einfache, reproduzierbare Methode mit hoher Akzeptanz bei den Patienten. Die mittlere Dosisbelastung am Herzen und an der linken Lunge kann damit deutlich reduziert werden, am Herzen sogar auf die Hälfte.

Schlüsselwörter

Brustkrebs - Brustbestrahlung - Kardiotoxizität - DIBH - SGRT

Key words

breast cancer - breast irradiation - cardiotoxicity - DIBH - SGRT

Publikationsverlauf

Artikel online veröffentlicht:
09. März 2020

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