Physica medica : PM : an international journal devoted to the applications of physics to medicine and biology : official journal of the Italian Association of Biomedical Physics (AIFB) · 2026
Comparison of heart-sparing efficacy between deep inspiration and end-expiration breath-hold in gastric MALT lymphoma radiotherapy: Spatial separation versus margin reduction.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Yang Qiangxing, Li Wenxiang, Wang Lihong, Sun Zihan, He Yu, Bu Luyi, Lu Zhongjie, Zhao Feng, Yan Senxiang
Аннотация
PURPOSE: This study aims to explore whether spatial separation in deep inspiration breath-hold (DIBH) or margin reduction in end-expiration breath-hold (EEBH) achieves heart-sparing efficacy in the radiotherapy (RT) of gastric mucosa-associated lymphoid tissue (MALT) lymphoma patients.
METHODS AND MATERIALS: 51 gastric MALT lymphoma patients treated between 2023-2025 were enrolled and trained for either DIBH or EEBH. Dosimetric parameters (heart and left ventricle V5-V30 and mean doses) were compared. Geometric relationships between the heart and target volume were characterized using distance-based metrics, and their association with cardiac dose reduction was evaluated using linear regression. Overlap-based indices were reported descriptively. Fifty CBCT-based IGRT deviations from audio-visual feedback (AVFB)-assisted DIBH patients were descriptively compared with EEBH.
RESULTS: Both DIBH and EEBH reduced cardiac doses compared with free breathing. Using relative dose reduction (Δdose) as the primary endpoint, DIBH was associated with greater reductions in low-dose parameters, particularly ΔV5. Increased spatial separation during DIBH correlated with greater low-dose reduction. CBCT-based positional analysis suggested consistent inter-fraction setup under AVFB-assisted DIBH.
CONCLUSIONS: This exploratory dosimetric study suggests that DIBH may be associated with greater reduction in cardiac dose, particularly for low-dose metrics. Increased spatial separation may serve as a geometric indicator of dose reduction. These findings should be interpreted as exploratory, and further studies are warranted to validate their clinical relevance.
METHODS AND MATERIALS: 51 gastric MALT lymphoma patients treated between 2023-2025 were enrolled and trained for either DIBH or EEBH. Dosimetric parameters (heart and left ventricle V5-V30 and mean doses) were compared. Geometric relationships between the heart and target volume were characterized using distance-based metrics, and their association with cardiac dose reduction was evaluated using linear regression. Overlap-based indices were reported descriptively. Fifty CBCT-based IGRT deviations from audio-visual feedback (AVFB)-assisted DIBH patients were descriptively compared with EEBH.
RESULTS: Both DIBH and EEBH reduced cardiac doses compared with free breathing. Using relative dose reduction (Δdose) as the primary endpoint, DIBH was associated with greater reductions in low-dose parameters, particularly ΔV5. Increased spatial separation during DIBH correlated with greater low-dose reduction. CBCT-based positional analysis suggested consistent inter-fraction setup under AVFB-assisted DIBH.
CONCLUSIONS: This exploratory dosimetric study suggests that DIBH may be associated with greater reduction in cardiac dose, particularly for low-dose metrics. Increased spatial separation may serve as a geometric indicator of dose reduction. These findings should be interpreted as exploratory, and further studies are warranted to validate their clinical relevance.