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Impact of Breath Hold Coaching and Home Practice On Surface-Tracked Deep Inspiratory Breath-Hold (DIBH) Radiotherapy in Patients with Left-Sided Breast Cancer

N Cao

A Kalet , A Kim , N Cao*, D Hippe , L Fang , N Mayr , University of Washington, Seattle, WA


SU-I-GPD-J-26 (Sunday, July 30, 2017) 3:00 PM - 6:00 PM Room: Exhibit Hall

Purpose: To evaluate the effect of systematic coaching and preparatory breath-hold training on the consistency of breath holding during DIBH for left breast radiation through comparison of motion tracking among coached and non-coached patients.

Methods: Motion tracking data of 50 consecutive patients treated for left breast cancer in DIBH technique were obtained by extracting Calypso surface transponder daily tracking reports. Twenty-two (22) patients were treated by a physician who provided DIBH coaching and home practice instructions at least 5 days prior to simulation, and 28 were non-coached under another physician's care. Tracking reports were processed using the R statistical language to analyze and characterize motion tracking stability and day-to-day variability according to utilization of coaching.

Results: In the first 5 fractions (first treatment week) the average maximum excursions for all dimensions (superior-inferior, anterior-posterior, right-left) were significantly smaller in coached compared to non-coached patients (p <0.05). The coached group had a mean decrease of 0.05 cm in maximum per fraction excursion compared to the non-coached group. This corresponds to a 13.9% decrease in maximum per fraction excursions relative to the non-coached group (average max excursion: 0.37 cm). No significant differences were found in average maximum excursion between patient groups in the subsequent second (p=0.63) and third (p=0.78) treatment weeks. The average standard deviation (stability measure) also tended to be 0.02 cm lower in the coached patients during the first week of treatment (p=0.070).

Conclusion: These results suggest that the training effect from systematic breath-hold coaching and preparatory practice improves patients’ ability to produce stable breath-holds during the initial radiation therapy fractions. The improvement of breath-hold stability in non-coached patients to that of coached patients later in the treatment course confirms the role of the training effect. Preparatory coaching may be particularly important in short fractionation schedules.

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