Prolonging deep inspiration breath-hold time to 3 min during radiotherapy, a simple solution.

Published on Feb 23, 2021in Clinical and Translational Radiation Oncology
· DOI :10.1016/J.CTRO.2021.02.007
Vincent Vakaet2
Estimated H-index: 2
(UGent: Ghent University),
Hans Van Hulle2
Estimated H-index: 2
(UGent: Ghent University)
+ 8 AuthorsLiv Veldeman15
Estimated H-index: 15
(UGent: Ghent University)
Source
Abstract
Abstract Background and purpose Deep inspiration breath-hold is an established technique to reduce heart dose during breast cancer radiotherapy. However, modern breast cancer radiotherapy techniques with lymph node irradiation often require long beam-on times of up to 5 minutes. Therefore, the combination with deep inspiration breath-hold (DIBH) becomes challenging. A simple support technique for longer duration deep inspiration breath-hold (L-DIBH), feasible for daily use at the radiotherapy department, is required to maximize heart sparing. Materials and methods At our department, a new protocol for multiple L-DIBH of at least 2 minutes and 30 seconds was developed on 32 healthy volunteers and validated on 8 breast cancer patients during radiotherapy treatment, using a pragmatic process of iterative development, including all major stakeholders. Each participant performed 12 L-DIBHs, on 4 different days. Different methods of pre-oxygenation and voluntary hyperventilation were tested, and scored on L-DIBH duration, ease of use, and comfort. Results Based on 384 L-DIBHs from 32 healthy volunteers, voluntary hyperventilation for 3 minutes whilst receiving high-flow nasal oxygen at 40L/min was the most promising technique. During validation, the median L-DIBH duration in prone position of 8 breast cancer patients improved from 59 seconds without support to 3 minutes and 9 seconds using the technique (p Conclusion A new and simple L-DIBH protocol was developed feasible for daily use at the radiotherapy center. Clinical trial registration number NCT04091542
📖 Papers frequently viewed together
56 Citations
2017
5 Authors (Lynsey Rice, ..., Patricia Price)
21 Citations
References42
Newest
#1Kyle M. Burk (UofU: University of Utah)H-Index: 4
#2Derek J. SakataH-Index: 7
Last. Joseph A. OrrH-Index: 14
view all 4 authors...
BACKGROUND: Supplemental oxygen is administered during procedural sedation to prevent hypoxemia. Continuous flow oxygen, the most widespread method, is generally adequate but distorts capnography. Pulsed flow oxygen is novel and ideally will not distort capnography. We have developed a prototype oxygen administration system designed to try to facilitate end-tidal carbon dioxide (ETCO2) measurement. We conducted a volunteer study (ClinicalTrials.gov, NCT02886312) to determine how much nasal ETCO2...
2 CitationsSource
#1Yingjie Xu (Peking Union Medical College)H-Index: 6
#2Jingbo Wang (Peking Union Medical College)H-Index: 1
Last. Shulian Wang (Peking Union Medical College)H-Index: 20
view all 8 authors...
Abstract The present study aimed to compare 4 techniques in the planning of locoregional irradiation including internal mammary nodal region for left-sided breast cancer. Ten patients with left-sided breast cancer undergoing breast conservation surgery were enrolled. For each patient, 4 treatment plans were performed: a helical tomotherapy (HT) plan, a volumetric modulated arc therapy (VMAT) plan, a static intensity modulated radiation therapy (IMRT) plan, and a hybrid IMRT plan, designed to enc...
8 CitationsSource
#1Geneviève Van Ooteghem (Cliniques Universitaires Saint-Luc)H-Index: 2
#2Damien Dasnoy-Sumell (UCL: Université catholique de Louvain)H-Index: 1
Last. Xavier Geets (UCL: Université catholique de Louvain)H-Index: 22
view all 4 authors...
Abstract Background and purpose Current motion mitigation strategies, like margins, gating, and tracking, deal with geometrical uncertainties in the tumour position, induced by breathing during radiotherapy (RT). However, they often overlook motion variability in amplitude, respiratory rate, or baseline position, when breathing spontaneously. Consequently, this may negatively affect the delivered dose conformality in comparison to the plan. We previously demonstrated on volunteers that 3 differe...
1 CitationsSource
#1Michael J. Parkes (NIHR: National Institute for Health Research)H-Index: 13
#1Michael J. Parkes (NIHR: National Institute for Health Research)H-Index: 6
Last. Thomas H. Clutton-Brock (NIHR: National Institute for Health Research)H-Index: 12
view all 6 authors...
Abstract Background & purpose Multiple, short breath-holds are now used in single radiotherapy treatment sessions. Here we investigated the feasibility and safety of multiple prolonged breath-holds in a single session. We measured how long is a second breath-hold if we prematurely terminate a single, prolonged breath-hold of >5 min either by using a single breath of oxygen (O2), or by reintroducing preoxygenation and hypocapnia. We also investigated the feasibility and safety of undertaking 9 pr...
7 CitationsSource
#1Ina M. Sala (WSU: Wayne State University)H-Index: 1
#2Girish B. Nair (Oakland University)H-Index: 7
Last. T.M. Guerrero (Oakland University)H-Index: 4
view all 4 authors...
Abstract High frequency percussive ventilation (HFPV) employs high frequency low tidal volumes (100–400 bursts/min) to provide respiration in awake patients while simultaneously reducing respiratory motion. The purpose of this study is to evaluate HFPV as a technique for respiratory motion immobilization in radiotherapy. In this study fifteen healthy volunteers (age 30–75 y) underwent HFPV using three different oral interfaces. We evaluated each HFPV oral interface device for compliance, ease of...
6 CitationsSource
#1Geneviève Van Ooteghem (Cliniques Universitaires Saint-Luc)H-Index: 2
#2Damien Dasnoy-Sumell (UCL: Université catholique de Louvain)H-Index: 1
Last. X. Geets (Cliniques Universitaires Saint-Luc)H-Index: 8
view all 7 authors...
Abstract Background and purpose When using highly conformal radiotherapy techniques, a stabilized breathing pattern could greatly benefit the treatment of mobile tumours. Therefore, we assessed the feasibility of Mechanically-assisted non-invasive ventilation (MANIV) on unsedated volunteers, and its ability to stabilize and modulate the breathing pattern over time. Materials and methods Twelve healthy volunteers underwent 2 sessions of dynamic MRI under 4 ventilation modes: spontaneous breathing...
7 CitationsSource
#1Nakia-Rae Beaton (Princess Alexandra Hospital)H-Index: 1
#2Sharon Watson (Princess Alexandra Hospital)H-Index: 1
Last. Margot Lehman (UQ: University of Queensland)H-Index: 15
view all 10 authors...
Introduction Evidence that Deep Inspiration Breath Hold (DIBH) can reduce cardiac dose during left‐sided breast radiation therapy (RT) has led to widespread uptake of this technology. There is a paucity of published information documenting the impact of this technique on the patient's treatment experience. The aim of this study was to develop a tool to assess the patient's experience with the introduction of DIBH using the Elekta® Active Breathing Coordinator (ABC) in a single institution. Metho...
3 CitationsSource
#1A. Kim (UW: University of Washington)H-Index: 1
#2Alan M. Kalet (UW: University of Washington)H-Index: 7
Last. Nina A. Mayr (UW: University of Washington)H-Index: 31
view all 9 authors...
Abstract Aims Deep inspiration breath hold (DIBH) reduces cardiac radiation exposure by creating cardiac–chest wall separation in breast cancer radiotherapy. DIBH requires sustaining chest wall expansion for up to 40 s and involves complex co-ordination of thoraco-abdominal muscles, which may not be intuitive to patients. We investigated the effect of in-advance preparatory DIBH coaching and home practice on cardiac doses. Materials and methods Successive patients from 1 February 2015 to 31 Dece...
7 CitationsSource
#1Benjamin D. Smith (University of Texas MD Anderson Cancer Center)H-Index: 62
#2Jennifer R. Bellon (Harvard University)H-Index: 36
Last. Reshma Jagsi (UM: University of Michigan)H-Index: 76
view all 16 authors...
Abstract Introduction The purpose of this guideline is to offer recommendations on fractionation for whole breast irradiation (WBI) with or without a tumor bed boost and guidance on treatment planning and delivery. Methods and materials The American Society for Radiation Oncology (ASTRO) convened a task force to address 5 key questions focused on dose-fractionation for WBI, indications and dose-fractionation for tumor bed boost, and treatment planning techniques for WBI and tumor bed boost. Guid...
220 CitationsSource
#1Carmen Bergom (MCW: Medical College of Wisconsin)H-Index: 14
#2Adam Currey (MCW: Medical College of Wisconsin)H-Index: 10
Last. Jonathan B. Strauss (NU: Northwestern University)H-Index: 17
view all 5 authors...
Historically, cardiac toxicity has diminished the benefits of radiation therapy for patients with left-sided breast cancer. Data suggests that there is not a threshold for the deleterious effects from radiation on the heart. Over the last several years, advances in radiation delivery techniques have reduced cardiac morbidity due to treatment. Deep-inspiration breath hold (DIBH) is a technique that takes advantage of a more favorable position of the heart during inspiration to minimize heart dose...
61 CitationsSource
Cited By1
Newest
#1Michael J. Parkes (NIHR: National Institute for Health Research)H-Index: 6
#2Wilfried De Neve (UGent: Ghent University)H-Index: 59
Last. Thomas H. Clutton-Brock (NIHR: National Institute for Health Research)H-Index: 12
view all 12 authors...
Objective:Breast cancer radiotherapy is increasingly delivered supine with multiple, short breath-holds. There may be heart and lung sparing advantages for locoregional breast cancer of both prone ...
Source