ESTRO 2024 - Abstract Book

S5727

RTT - Patient experience and quality of life

ESTRO 2024

Purpose/Objective:

The aim of this study is to show the impact of the DIBH technique on the quality of life of patients=QoL, irradiated with this technique. The DIBH technique was implemented at the Amethyst Center Timisoara in January 2023 and involves starting the irradiation beam only when the patient is in deep inspiration and thus has the advantage of decreasing target movement and limiting the dose in healthy tissues.

Material/Methods:

The C-RAD Catalyst system is an optical surface scanner that ensures optimal positioning of the patient thanks to SGRT as well as optimal irradiation through the DIBH technique.Visual coaching solutions:googles,tablet,light panel.In the period 16 Jan-16 Oct 2023, a total of 40 patients with left-sided breast cancer benefited from this technique.The patient was considered eligible if she was able to hold her breath for 30-second before the simulation.All patients were informed by the radiation oncologyst about this technique.All patients followed the same breathing exercise protocol at home 4 days before the CT scan.All patients were scanned on Philipss Big Bore -2 series were acquired at the scan:FB and DIBH.The DIBH point was marked at the xiphoid appendix, patient head turned contralateral and the amplitude was measured throught the treatment planning system.All patients were treated with Elekta Infinity accelerator,6 MV,dose prescription 50-66 Gy,2Gy/fraction, VMAT technique.All patients chose,at the first irradiation session the visual coaching.All patients were followed audio and video and RTT communicated verbally-clearly and concisely the breathing instructions.QoL assessment was done in comparison with 40 patients with the same staging and age groups. The DIBH technique has a major impact on QoL, poor breath control results in prolonged treatment delivery time, prolonged irradiation resulting in arm pain and increased anxiety, insomnia and fatigue compared to usual techniques. These aspects are reflected in the time needed to deliver the treatment.In the case of cooperative patients the treatment delivery time is 15-20 minutes.In the case of anxious patients, baggy breathing has been found to cause difficulty in reaching the DIBH interval and prolonging the treatment time by 40-45 minutes/ A vicious circle has formed - baggy breathing - non-DIBH interval - anxiety - baggy breathing. In patients who failed to maintain 30 seconds of deep inspiration, several breaths were required to deliver an arc, treatment time required 20-30 minutes. In the case of cooperative patients the treatment delivery time is 15-20 minutes.All patients were irradiated DIBH plan,no need to import the backup FB-plan.All patients stated at the simulation that it is not difficult to be in deep inspiration,but the real challenge was at Linac,where patients realized that the time needed to deliver the treatment is longer than the time needed for CT scans. The amplitude variated between 8 and 20 mm with a median value of 14 mm. There was no correlation between the amplitude and QoL. Results:

Conclusion:

DIBH has important role in achieving the goal of therapy it is possible to reach a therapeutic index close to 1,because it is possible to follow in real time the optimal treatment delivery .Qol of the patient's life without DIBH is impacted by DIBH, but for the future these patients will have better Qol than irradiated patients without DIBH. Clear communication between staff and patient is a key component with written instructions and protocols.

Keywords: breast cancer, DIBH,QoL