Prolonging deep inspiration breath-hold time to 3 min during radiotherapy, a simple solution.
Clin Transl Radiat Oncol 2021;
28:10-16. [PMID:
33732910 PMCID:
PMC7941008 DOI:
10.1016/j.ctro.2021.02.007]
[Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/17/2021] [Accepted: 02/17/2021] [Indexed: 01/07/2023] Open
Abstract
A new protocol was developped to prolong deep inspiration breath-holds.
Multiple prolonged breath-holds are achievable with minimal side effects.
DIBH was prolonged to 3 min using HFNO and hyperventilation in breast cancer patients.
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 min. 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 min and 30 s 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 min whilst receiving high-flow nasal oxygen at 40 L/min was the most promising technique. During validation, the median L-DIBH duration in prone position of 8 breast cancer patients improved from 59 s without support to 3 min and 9 s using the technique (p < 0.001).
Conclusion
A new and simple L-DIBH protocol was developed feasible for daily use at the radiotherapy center.
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