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Impact of the Visual Feedback on Cardiac-sparing Radiation Therapy with Deep Breath-holding for Left Breast Cancer
Proceedings of the 50th Annual ASTRO Meeting 64.4% of the patients. No patient had symptomatic pulmonary or cardiac toxicity. At a median follow-up of 17 months (range, 5-42 months) skin/subcutaneous tissue toxicity evaluated in 56 patients was G0 in 21 (37.5%), G1 in 31 (55.3%) and G2 in 4 (7.1%). Conclusions: The concomitant treatment caused a high rate of acute severe (G3) skin toxicity that recovered at longer follow-up. The limited prolongation of the RT course could potentially be compensated by a higher local and systemic efficacy due to the addictive effect of the simultaneous administration. Author Disclosure: G.B. Ivaldi, None; M. Leonardi, None; A. Ferrari, None; A. Morra, None; B. Jereczek Fossa, None; A. Vavassori, None; L. Santoro, None; R. Orecchia, None.
2028
Impact of the Visual Feedback on Cardiac-sparing Radiation Therapy with Deep Breath-holding for Left Breast Cancer
K. N. Murofushi, M. Oguchi, T. Kozuka, T. Nose, T. Yamashita Cancer Institute Hospital of the Japan Foundation for Cancer Research, Tokyo, Japan Purpose/Objective(s): Radiation Therapy (RT) with the deep inspiration breath-holding (DIBH) technique has been reported to reduce the irradiated cardiac volume in breast conserving treatment. The chest wall excursion for DIBH and the position during DIBH above end-expiratory level were high, and gave poor reproducibility. In order to improve the reproducibility, the visual feedback method, which showed patients a real-time trace of their chest wall motion due to breathing, has been investigated. We evaluated the feasibility of using the visual feedback and effect on reproducibility during RT with DIBH. Materials/Methods: The study included 40 patients, 22 of them were applied the visual feedback, and 18 were not. Before planning CT scanning, each patient received a standardized respiratory training session individually. Respiratory motion was continuously monitored during CT-scanning and simulation with the RPM system, Varian Medical System Inc. The motion of RPM marker placed on left lower chest wall correlate very closely with the respiratory chest wall position (Nakajima et al. Japan Radiological Society 2008). The position during DIBH above end-expiratory level and the chest wall excursion for DIBH were measured during CT-scanning and simulation for each 15 seconds. We calculated the difference of respiratory reproducibility with or without the visual feedback. Results: During free breath the mean chest wall position with or without the visual feedback were 4.7 mm and 5.7 mm (p = 0.1). There is no difference of mean chest wall positions between with or without the visual feedback during CT obtained with DIBH (18.6 vs. 18.4 mm, p = 0.50) and during simulation (22.1 mm vs. 21.6 mm, p = 0.67). The differences between the chest wall motion during CT-scanning and simulation with or without the visual feedback were 1.0 mm (range, 0.0-3.0) vs. 4.7 mm (range, 0.6-8.7). The visual feedback provided a significant greater reduction of chest wall motion (p\0.001). The 15 seconds chest wall excursions for DIBH with or without were 2.0 mm (range, 0.7-4.7) vs. 4.1 mm (range, 0.7-11.5). The visual feedback provided a significant greater reduction (p \ 0.001). Conclusions: The visual feedback has the capability to reduce a scatter of the respiratory chest wall motion and the excursions. This may improve the reproducibility and increase the accuracy of radiotherapy with deep inspiration breath-holding. Author Disclosure: K.N. Murofushi, None; M. Oguchi, None; T. Kozuka, None; T. Nose, None; T. Yamashita, None.
2029
Prevention of Radiation Dermatitis using Light-emitting Diode (LED) Photomodulation: A Prospective, Randomized, and Controlled Study
J. C. Cheng, D. Fife, S. Behnam, L. Elkeeb, J. V. Kuo, N. Ramsinghani University of California Irvine Medical Center, Orange, CA Purpose/Objective(s): Radiation dermatitis (RD) occurs in over 75% of breast cancer patients receiving radiation therapy. The RD can often be quite severe, necessitating cessation or delay of treatment and thus, sub-optimal results. DeLand et al. reported a decreased incidence and severity of RD after administration of LED photomodulation following each radiation treatment. This study is the first prospective, randomized, controlled study evaluating the value of LED for prevention or attenuation of RD. Materials/Methods: The LED photomodulation was given through The Gentlewaves Select, which uses a 590 nm low-energy light, which flashes in a programmed sequence thought to regulate or manipulate cell activity without the use of a thermal effect. Twenty-eight post-surgical (lumpectomy or mastectomy) breast cancer patients were randomly assigned to treatment or control groups. Treatment group received LED before and after each radiation treatment with Gentlewaves Select. Seven additional treatments were administered after cessation of radiation. Each treatment lasts 35 seconds (100 pulses; pulse sequence of 250 ms on/100 ms off). Control group received ‘‘sham’’ treatments (eyes covered, LED held on skin but turned off). All radiation treatments were given through 3D-conformal radiotherapy. All subjects used Aquaphor for skin care. Subjects were examined and photographed weekly. Photographs were graded by blinded dermatologists and radiation oncologist utilizing the RTOG Acute Radiation Morbidity Scoring Criteria (Grade levels 0-6). Changes in grading score from week 5 after the start of radiation therapy were compared with the baseline score for each individual patient. The differences were recorded for each group and the mean difference was compared between the groups and analyzed using unpaired t test for statistical significance. Results: The LED treatment group (n = 13) demonstrated Grade 0-1 reactions in 53.3%, Grade 2-3 reactions in 46.7%, and Grade 4 or above in 0% of patients. Control group (n = 15) demonstrated Grade 0-1 reactions in 53.8%, Grade 2-3 reactions in 30.8%, and Grade 4 or above in 15.4% of patients. No Grade 5 or 6 was observed in either control or treatment groups. No adverse effects related to LED were noted. The mean change in score for LED control group was 1.92 and for LED treatment group was 1.73. The mean of LED control group minus LED treatment group equals 0.19 (95% CI, -0.70 to 1.08). The differences between the two group was not statistically significant (p = 0.6644). Conclusions: We did not demonstrate a reduced incidence or degree of radiation dermatitis when radiation therapy was administered in conjunction with LED. Additional planned studies will further investigate whether LED has a role in radiation dermatitis prevention. Author Disclosure: J.C. Cheng, None; D. Fife, None; S. Behnam, None; L. Elkeeb, None; J.V. Kuo, None; N. Ramsinghani, None.
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2028
Impact of the Visual Feedback on Cardiac-sparing Radiation Therapy with Deep Breath-holding for Left Breast Cancer
K. N. Murofushi, M. Oguchi, T. Kozuka, T. Nose, T. Yamashita Cancer Institute Hospital of the Japan Foundation for Cancer Research, Tokyo, Japan Purpose/Objective(s): Radiation Therapy (RT) with the deep inspiration breath-holding (DIBH) technique has been reported to reduce the irradiated cardiac volume in breast conserving treatment. The chest wall excursion for DIBH and the position during DIBH above end-expiratory level were high, and gave poor reproducibility. In order to improve the reproducibility, the visual feedback method, which showed patients a real-time trace of their chest wall motion due to breathing, has been investigated. We evaluated the feasibility of using the visual feedback and effect on reproducibility during RT with DIBH. Materials/Methods: The study included 40 patients, 22 of them were applied the visual feedback, and 18 were not. Before planning CT scanning, each patient received a standardized respiratory training session individually. Respiratory motion was continuously monitored during CT-scanning and simulation with the RPM system, Varian Medical System Inc. The motion of RPM marker placed on left lower chest wall correlate very closely with the respiratory chest wall position (Nakajima et al. Japan Radiological Society 2008). The position during DIBH above end-expiratory level and the chest wall excursion for DIBH were measured during CT-scanning and simulation for each 15 seconds. We calculated the difference of respiratory reproducibility with or without the visual feedback. Results: During free breath the mean chest wall position with or without the visual feedback were 4.7 mm and 5.7 mm (p = 0.1). There is no difference of mean chest wall positions between with or without the visual feedback during CT obtained with DIBH (18.6 vs. 18.4 mm, p = 0.50) and during simulation (22.1 mm vs. 21.6 mm, p = 0.67). The differences between the chest wall motion during CT-scanning and simulation with or without the visual feedback were 1.0 mm (range, 0.0-3.0) vs. 4.7 mm (range, 0.6-8.7). The visual feedback provided a significant greater reduction of chest wall motion (p\0.001). The 15 seconds chest wall excursions for DIBH with or without were 2.0 mm (range, 0.7-4.7) vs. 4.1 mm (range, 0.7-11.5). The visual feedback provided a significant greater reduction (p \ 0.001). Conclusions: The visual feedback has the capability to reduce a scatter of the respiratory chest wall motion and the excursions. This may improve the reproducibility and increase the accuracy of radiotherapy with deep inspiration breath-holding. Author Disclosure: K.N. Murofushi, None; M. Oguchi, None; T. Kozuka, None; T. Nose, None; T. Yamashita, None.
2029
Prevention of Radiation Dermatitis using Light-emitting Diode (LED) Photomodulation: A Prospective, Randomized, and Controlled Study
J. C. Cheng, D. Fife, S. Behnam, L. Elkeeb, J. V. Kuo, N. Ramsinghani University of California Irvine Medical Center, Orange, CA Purpose/Objective(s): Radiation dermatitis (RD) occurs in over 75% of breast cancer patients receiving radiation therapy. The RD can often be quite severe, necessitating cessation or delay of treatment and thus, sub-optimal results. DeLand et al. reported a decreased incidence and severity of RD after administration of LED photomodulation following each radiation treatment. This study is the first prospective, randomized, controlled study evaluating the value of LED for prevention or attenuation of RD. Materials/Methods: The LED photomodulation was given through The Gentlewaves Select, which uses a 590 nm low-energy light, which flashes in a programmed sequence thought to regulate or manipulate cell activity without the use of a thermal effect. Twenty-eight post-surgical (lumpectomy or mastectomy) breast cancer patients were randomly assigned to treatment or control groups. Treatment group received LED before and after each radiation treatment with Gentlewaves Select. Seven additional treatments were administered after cessation of radiation. Each treatment lasts 35 seconds (100 pulses; pulse sequence of 250 ms on/100 ms off). Control group received ‘‘sham’’ treatments (eyes covered, LED held on skin but turned off). All radiation treatments were given through 3D-conformal radiotherapy. All subjects used Aquaphor for skin care. Subjects were examined and photographed weekly. Photographs were graded by blinded dermatologists and radiation oncologist utilizing the RTOG Acute Radiation Morbidity Scoring Criteria (Grade levels 0-6). Changes in grading score from week 5 after the start of radiation therapy were compared with the baseline score for each individual patient. The differences were recorded for each group and the mean difference was compared between the groups and analyzed using unpaired t test for statistical significance. Results: The LED treatment group (n = 13) demonstrated Grade 0-1 reactions in 53.3%, Grade 2-3 reactions in 46.7%, and Grade 4 or above in 0% of patients. Control group (n = 15) demonstrated Grade 0-1 reactions in 53.8%, Grade 2-3 reactions in 30.8%, and Grade 4 or above in 15.4% of patients. No Grade 5 or 6 was observed in either control or treatment groups. No adverse effects related to LED were noted. The mean change in score for LED control group was 1.92 and for LED treatment group was 1.73. The mean of LED control group minus LED treatment group equals 0.19 (95% CI, -0.70 to 1.08). The differences between the two group was not statistically significant (p = 0.6644). Conclusions: We did not demonstrate a reduced incidence or degree of radiation dermatitis when radiation therapy was administered in conjunction with LED. Additional planned studies will further investigate whether LED has a role in radiation dermatitis prevention. Author Disclosure: J.C. Cheng, None; D. Fife, None; S. Behnam, None; L. Elkeeb, None; J.V. Kuo, None; N. Ramsinghani, None.
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