Continuous Positive Airway Pressure for Motion Management in Stereotactic Body Radiation Therapy to the Lung: A Controlled Pilot Study

Goldstein, Jeffrey; Lawrence, Yaacov Richard; Appel, Sarit; Landau, Efrat; Ben‐David, Merav; Rabin, Tatiana; Ben-Ayun, Maoz; Dubinski, S.; Weizman, Noam; Alezra, D.; Gnessin, H.; Goldstein, A.; Baidun, Khader; Segel, Michael J.; Peled, Nir; Symon, Zvi

doi:10.1016/j.ijrobp.2015.06.011

Cited by 34 publications

(38 citation statements)

References 22 publications

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“…The improvements observed in this case were largely consistent with our earlier findings, which showed an increase in total lung volume and decrease in dose to the lung and heart 6 . Although CPAP had no effect on GTV in our earlier study, in this case report, GTV was reduced by 46% because of reexpansion of the lung and improved identification of tumor for contouring 6 . The decreases in lung V5, V20, and MLD with CPAP were less than expected because some of the reexpanded lung was irradiated.…”

Section: Discussionsupporting

confidence: 92%

“…Recently, our group reported reduced tumor motion and expanded lung volumes in patients who received stereotactic body RT with CPAP 6 . The improvements observed in this case were largely consistent with our earlier findings, which showed an increase in total lung volume and decrease in dose to the lung and heart 6 .…”

Section: Discussionsupporting

confidence: 91%

“…Resolution of atelectasis was not an indication for participation. After obtaining informed consent, CPAP training began within the RT department before CT simulation by administering CPAP for 1 hour at 15 cm H 2 O 6 . After 30 minutes, she complained of vertigo, headache, and weakness and refused further training or CT simulation.…”

Section: Case Presentationmentioning

confidence: 99%

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Reexpansion of atelectasis caused by use of continuous positive airway pressure (CPAP) before radiation therapy (RT)

Appel

Weizman

Davidson

et al. 2016

Advances in Radiation Oncology

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IntroductionAlthough radiation therapy (RT) is an effective treatment for malignant atelectasis, its accurate delivery is challenging because of difficulty differentiating between tumor and atelectatic lung. Furthermore, reexpansion of lung during treatment repositions tumor and normal structures necessitating replanning to ensure treatment accuracy. Facilitating lung reexpansion before initiation of RT may improve RT treatment accuracy, spare normal tissue, and reduce obstructive symptoms. We report a case of reexpansion of right upper lobe (RUL) atelectasis caused by use of continuous positive airway pressure (CPAP) before RT.Case reportA 52-year-old woman presented with dyspnea and cough. Imaging studies showed an RUL mass with atelectasis. Bronchoscopy showed extrinsic compression of the RUL and middle lobe bronchi. Biopsy showed small cell lung cancer. Staging with positron emission tomography-computed tomography (CT) and contrast enhanced CT of brain showed no other disease. Following 4 cycles of platinum-based chemotherapy, CT imaging showed a decrease in tumor volume, but persistent RUL atelectasis. She agreed to participate in an institutional study to evaluate the use of CPAP to reduce respiratory motion and immobilize tumors during RT. During CPAP training, she complained of vertigo, headache, and weakness and refused simulation. The next day she reported less dyspnea and completed training and CT simulation without difficulty. CT simulation with CPAP showed reexpansion of the RUL. Lung volume increased from 2170 to 3767 mL (74 %). Gross tumor volume, clinical volume, and planning volume decreased 46%, 45%, and 38%, respectively. Mean lung dose and mean heart dose decreased 20% and 51%, respectively. CPAP was used daily for 1 hour before and during treatment. Cone beam CT scans showed that the RUL remained inflated throughout treatment.ConclusionThis is the first reported use of CPAP for reexpansion of atelectasis before RT planning and treatment. Reexpansion of atelectasis improved RT planning, decreased dose to uninvolved lung, and removed the need for replanning. Further study of CPAP as an initial intervention to improve RT delivery in patients with malignant atelectasis is warranted.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 91%

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Reexpansion of atelectasis caused by use of continuous positive airway pressure (CPAP) before radiation therapy (RT)

Appel

Weizman

Davidson

et al. 2016

Advances in Radiation Oncology

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“…A compensation for respiratory tumor motion needs to be considered in order to reduce ITV margins [12,13]. However, the breath-hold method has limitations for elderly patients and patients with severe pulmonary diseases such as chronic obstructive pulmonary disease.…”

Section: Introductionmentioning

confidence: 99%

A phase I/II study on stereotactic body radiotherapy with real-time tumor tracking using CyberKnife based on the Monte Carlo algorithm for lung tumors

et al. 2017

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“…Goldstein et al published a novel technique to improve thoracic radiotherapy utilizing a well-known technology CPAP (continuous positive airway pressure) to improve thoracic dosimetry [6]. Since CPAP has not been extensively studied in breast cancer we chose to examine its use compared to standard of care tangential radiation without breath hold or other techniques.…”

Section: Introductionmentioning

confidence: 99%

CPAP (Continuous Positive Airway Pressure) is an effective and stable solution for heart sparing radiotherapy of left sided breast cancer

et al. 2020

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Purpose: Limiting the heart dose in left sided breast cancer radiotherapy is critical. We sought to study the effect of using CPAP (continuous positive airway pressure) as an aid in reducing heart dose in breast cancer radiotherapy. Methods: Patients with left sided breast cancer receiving adjuvant radiotherapy were enrolled on a prospective IRB (institutional review board) approved clinical trial utilizing CPAP during radiotherapy. Each patient was simulated and planned with and without CPAP and the best dosimetric results determined the patient's treatment. Data on the differences in lung and heart volume and position as well as boost cavity position with and without CPAP were analyzed. Results: Twenty-four women from 10/16 to 10/18 were enrolled. Seven patients were not treated on study; only two of these were due to treatment issues. Median age was 54 years. 70% had breast only radiation and 30% were treated to breast\CW (chest wall) and regional nodes. The median lung volume with CPAP was 60% larger than without CPAP. (1637 vs. 996 cc) p < 0.001. The median heart volume decreased 12% with CPAP. (338 vs. 382 cc) In regards to the DVH, CPAP decreased mean heart dose from 3.02 to 1.6Gy (p = .0075) and V20 of the lungs from 17.1 to 13.8 with CPAP but this was not significant. Conclusion: CPAP assisted radiotherapy was tolerable and produced superior treatment plans in left sided breast cancer. This method is worthy of further investigation as a method to normal tissue sparing treatment of left sided breast cancer patients.

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Continuous Positive Airway Pressure for Motion Management in Stereotactic Body Radiation Therapy to the Lung: A Controlled Pilot Study

Cited by 34 publications

References 22 publications

Reexpansion of atelectasis caused by use of continuous positive airway pressure (CPAP) before radiation therapy (RT)

Reexpansion of atelectasis caused by use of continuous positive airway pressure (CPAP) before radiation therapy (RT)

A phase I/II study on stereotactic body radiotherapy with real-time tumor tracking using CyberKnife based on the Monte Carlo algorithm for lung tumors

CPAP (Continuous Positive Airway Pressure) is an effective and stable solution for heart sparing radiotherapy of left sided breast cancer

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