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)
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
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