Deep Inspiration Breath Hold—Based Radiation Therapy: A Clinical Review

Boda-Heggemann, Judit; Knopf, Antje; Simeonova-Chergou, Anna; Wertz, H.; Stieler, Florian; Jahnke, Anika; Jahnke, L.; Fleckenstein, Jens; Vogel, Lena; Arns, Anna; Blessing, Manuel; Wenz, Frederik; Lohr, Frank

doi:10.1016/j.ijrobp.2015.11.049

Cited by 200 publications

(160 citation statements)

References 189 publications

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“…Each patient was asked to perform 30-second inhale BHs as is used for many treatment sites, including abdominal tumors [14]. On each measurement day, the patient, if able, performed three consecutive BHs on day 5, 10 and the last day of the treatment (i.e.…”

Section: Patient Population and Feasibilitymentioning

confidence: 99%

“…To eliminate respiratory-induced tumor motion, breathholding (BH) techniques, either at exhale or at inhale, are widely used for a variety of clinical applications [7][8][9][10][11][12][13][14]. For example, inhale BH is often used for breast cancer patients to increase the distance between the heart and the planning target volume [13].…”

mentioning

confidence: 99%

“…For example, in abdominal cancer patients inhale BH is being used on a daily base in many clinics [10,14]. For inhale BHs, the position variation between consecutive BHs within one fraction has been reported to be up to 7.0 mm for the diaphragm [7] and 2.5 mm for pancreatic tumors [10].…”

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confidence: 99%

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Considerable pancreatic tumor motion during breath-holding

et al. 2016

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Background: Breath-holding (BH) is often used to reduce abdominal organ motion during radiotherapy. However, for inhale BH, abdominal tumor motion during BH has not yet been investigated. The aim of this study was to quantify tumor motion during inhale BH and tumor position variations between consecutive inhale BHs in pancreatic cancer patients. Material and methods: Twelve patients with intratumoral fiducials were included and asked to perform three consecutive 30-second inhale BHs on each of three measurement days. During BH, lateral fluoroscopic movies were obtained and a two-dimensional (2D) image correlation algorithm was used to track the fiducials and the diaphragm, yielding the tumor and diaphragm motion during each BH. The tumor position variation between consecutive BHs was obtained from the difference in initial tumor position between consecutive BHs on a single measurement day. Results: We observed tumor motion during BH with a mean absolute maximum displacement over all BHs of 4.2 mm (range 1.0-11.0 mm) in inferior-superior (IS) direction and 2.7 mm (range 0.5-8.0 mm) in anterior-posterior (AP) direction. We found only a moderate correlation between tumor and diaphragm motion in the IS direction (Pearson's correlation coefficient jrj>0.6 in 45 of 76 BHs). The mean tumor position variation between consecutive BHs was 0.2 [standard deviation (SD) 1.7] mm in the inferior direction and 0.5 (SD 0.8) mm in the anterior direction. Conclusion: We observed substantial pancreatic tumor motion during BH as well as considerable position variation between consecutive BHs on a single day. We recommend further quantifying these uncertainties before introducing breath-hold during radiation treatment of pancreatic cancer patients. Also, the diaphragm cannot be used as a surrogate for pancreatic tumor motion.

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Section: Patient Population and Feasibilitymentioning

confidence: 99%

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Considerable pancreatic tumor motion during breath-holding

et al. 2016

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“…Respiratory-related motion of 2–3 cm 1 remains a major problem in radiotherapy planning and delivery for most thoracic and abdominal cancers. Such motion requires substantial enlargement (by 1 cm or more) in the planned treatment field and encroachment on vital structures.…”

Section: Introductionmentioning

confidence: 99%

Safely prolonging single breath-holds to >5 min in patients with cancer; feasibility and applications for radiotherapy

Parkes

Green

Stevens

et al. 2016

BJR

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Objective:Multiple, short and deep inspiratory breath-holds with air of approximately 20 s are now used in radiotherapy to reduce the influence of ventilatory motion and damage to healthy tissue. There may be further clinical advantages in delivering each treatment session in only one single, prolonged breath-hold. We have previously developed techniques enabling healthy subjects to breath-hold for 7 min. Here, we demonstrate their successful application in patients with cancer.Methods:15 patients aged 37–74 years undergoing radiotherapy for breast cancer were trained to breath-hold safely with pre-oxygenation and mechanically induced hypocapnia under simulated radiotherapy treatment conditions.Results:The mean breath-hold duration was 5.3 ± 0.2 min. At breakpoint, all patients were normocapnic and normoxic [mean end-tidal partial pressure of carbon dioxide was 36 ± 1 standard error millimetre of mercury, (mmHg) and mean oxygen saturation was 100 ± 0 standard error %]. None were distressed, nor had gasping, dizziness or disturbed breathing in the post-breath-hold period. Mean blood pressure had risen significantly from 125 ± 3 to 166 ± 4 mmHg at breakpoint (without heart rate falling), but normalized within approximately 20 s of the breakpoint. During breath-holding, the mean linear anteroposterior displacement slope of the L breast marker was <2 mm min−1.Conclusion:Patients with cancer can be trained to breath-hold safely and under simulated radiotherapy treatment conditions for longer than the typical beam-on time of a single fraction. We discuss the important applications of this technique for radiotherapy.Advances in knowledge:We demonstrate for the first time a technique enabling patients with cancer to deliver safely a single prolonged breath-hold of >5 min (10 times longer than currently used in radiotherapy practice), under simulated radiotherapy treatment conditions.

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“…Deep-inspiration breath-hold (DIBH) technique has a long history to reduce position uncertainty of respiratory moving tumors or to reduce dose to heart for breast radiotherapy [1]. Spirometry was employed to reduce the position uncertainty of a lung tumor by assuming good correlation between the tumor position and a lung volume [2].…”

Section: Introductionmentioning

confidence: 99%

A Half-Arc Multiple Deep-Inspiration Breath-Hold Volumetric Modulated Arc Therapy for a Lung Tumor with 10 MV Flattening-Filter-Free Beams and an Image Sensor Measuring a Distance Map to Thorax Surface: An Initial Clinical Experience

Nakagawa¹,

Nawa²,

Hashimoto³

et al. 2017

IJMPCERO

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A technique for multiple deep-inspiration breath-hold (DIBH) volumetric modulated arc therapy (VMAT) for a lung tumor has been proposed with 10 MV flattening-filter-free beams and an image sensor measuring a distance map to thorax surface. Planning CT images were acquired under a DIBH condition and a clinical target volume (CTV) was contoured. This procedure was repeated five times and an internal target volume (ITV) among the multiple DIBHs was created by integrating the five CTVs. A planning target volume (PTV) was defined by adding an isotropic margin of 5 mm to the ITV. Immediately before treatment, a 30-second half-arc cone-beam computer tomography (CBCT) imaging was performed under another DIBH condition, and the couch was repositioned so that tumor may be located inside the PTV contours. An infrared distance measurement device having laser diodes and an image sensor was attached to the couch, and a distance map to the patient thorax surface was recorded as a reference during still another DIBH condition. A half-arc segmented VMAT beams with two beam interrupts were delivered to the patient under multiple DIBHs, where the delivery time of each of the three segmented beams was 30 seconds. During the beam delivery, the distance map was monitored in real time to confirm that the distance to the thorax surface remained unchanged. In-treatment CBCT images suggested that the tumor position at the time of tumor registration was accurately reHow to cite this

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Deep Inspiration Breath Hold—Based Radiation Therapy: A Clinical Review

Cited by 200 publications

References 189 publications

Considerable pancreatic tumor motion during breath-holding

Considerable pancreatic tumor motion during breath-holding

Safely prolonging single breath-holds to >5 min in patients with cancer; feasibility and applications for radiotherapy

A Half-Arc Multiple Deep-Inspiration Breath-Hold Volumetric Modulated Arc Therapy for a Lung Tumor with 10 MV Flattening-Filter-Free Beams and an Image Sensor Measuring a Distance Map to Thorax Surface: An Initial Clinical Experience

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