Safely achieving single prolonged breath-holds of > 5 minutes for radiotherapy in the prone, front crawl position

Abstract

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 treatment and in a single breath-hold. We test here whether single prolonged breath-holds are possible in the prone, front crawl position. Methods: 19 healthy volunteers were trained to deliver supine, single prolonged breath-holds with pre-oxygenation and hypocapnia. We tested whether all could achieve the same durations in the prone, front crawl position. Results: 19 healthy volunteers achieved supine, single prolonged breath-holds for mean of 6.2 ± 0.3 min. All were able to hold safely for the same duration while prone (6.1 ± 0.2 min ns. by paired ANOVA). With prone, the increased weight on the chest did not impede chest inflation, nor the ability to hold air in the chest. Thus, the rate of chest deflation (mean anteroposterior deflation movement of three craniocaudally arranged surface markers on the spinal cord) was the same (1.2 ± 0.2, 2.0 ± 0.4 and 1.2 ± 0.4 mm/min) as found previously during supine prolonged breath-holds. No leakage of carbon dioxide or air was detectable into the facemask. Conclusion: Single prolonged (>5 min) breath-holds are equally possible in the prone, front crawl position. Advances in knowledge: Prolonged breath-holds in the front crawl position are possible and have the same durations as in the supine position. Such training would therefore be feasible for some patients with breast cancer requiring loco-regional irradiation. It would have obvious advantages for hypofractionation.

Efficacy of preoxygenation administration in volunteers, in extending the end-expiration breath-hold duration for application to abdominal radiotherapy

“…We did not see any significant changes in heart rate or SpO 2 which agrees with previous studies [10] , [11] , [14] , [15] . We also found no significant change in blood pressure for each of the tests which is different to the findings of other authors [10] , [11] , [14] , [15] .…”

“…We did not see any significant changes in heart rate or SpO 2 which agrees with previous studies [10] , [11] , [14] , [15] . We also found no significant change in blood pressure for each of the tests which is different to the findings of other authors [10] , [11] , [14] , [15] . This difference is likely due to the relatively shorter duration of BHs when compared to the BH durations as high as 5 min [11] , [15] .…”

“…This study was designed to determine if preoxygenation with hyperventilation is feasible to increase the EEBH duration to minimise the number of BH cycles required for an abdominal SABR treatment. It has been well established that inspiration BH durations can be significantly increased with the use of preoxygenation [8] , [10] , [11] , [12] , [13] , [15] , [19] . We demonstrated that there was a substantial increase in duration in EEBH time between breathing oxygen and hyperventilating compared with breathing room air which is consistent with Roth et al .…”

“…It has been demonstrated that by administering oxygen at a rate of 10 l/min as well as hyperventilating with oxygen prior to an inspired BH, an increase in BH duration of up to 700% can be achieved [8] . There are several other studies demonstrating that the administration of oxygen prior to treatment using DIBH, can at least double the BH duration [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] . In contrast, there are very few studies showing similar results for EEBH [16] .…”

Reproducibility of repeated breathhold and impact of breathhold failure in whole breast and regional nodal irradiation in prone crawl position

“…The use of multiple RBH maneuvers within one treatment sessions increases treatment time. However, research on single prolonged breathholds of > 5 min in the prone position shows much promise in limiting these interruptions 33 .…”