Visually guided inspiration breath-hold facilitated with nasal high flow therapy in locally advanced lung cancer

Abstract

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Enhanced Deep-Inspiration Breath Hold Superior to High-Frequency Percussive Ventilation for Respiratory Motion Mitigation: A Physiology-Driven, MRI-Guided Assessment Toward Optimized Lung Cancer Treatment With Proton Therapy

“…The achieved breath-hold durations were similar or longer than the time required to deliver representative PBS proton treatment fields at PSI's Gantry-2 for typical lung tumors. A recent study using a different method to extend breath-hold duration in pulmonary patients (a majority with stage III lung cancer) reported a mean breath-hold duration of 78 s (range 29–223 s) during conventional RT treatment ( 55 ). Thus, the increase in breath-hold duration by eDIBH in the healthy subjects of the present study is likely transferrable to lung cancer patients allowing irradiation of adequate PBS-PT fields.…”

“…Physiologically, the results suggest that the eDIBH procedure could benefit patients that need to achieve a breath-hold duration of ≥60–90 s for irradiation therapy. Although, it can be expected that such durations can be achieved in cancer patients without lung morbidity and despite such breath-hold durations having been reported in lung cancer patients ( 55 ), further investigations are needed to test the extent to which compromised lung function influences overall breath-hold performance.…”

Treatment planning and 4D robust evaluation strategy for proton therapy of lung tumors with large motion amplitude

“…Based on the results of this study, we have started to treat lung cancer patients with a tumor movement up to 20 mm clinically. To include patients with an even larger tumor movement or an overlap between the ITVp and the diaphragm on one or more of the 4DCT (currently exclusion criteria), we are investigating the possibility to treat in breath hold 32 . Other studies have also investigated the use of the breath‐hold technique for the treatment of lung tumors 12,33 .…”

“…To include patients with an even larger tumor movement or an overlap between the ITVp and the diaphragm on one or more of the 4DCT (currently exclusion criteria), we are investigating the possibility to treat in breath hold. 32 Other studies have also investigated the use of the breath‐hold technique for the treatment of lung tumors. 12 , 33 The advances of the breath hold technique include a reduction of dose to the OARs, which could lead to a lower risk of side effects.…”

Shortening the preparation time of the single prolonged breath-hold for radiotherapy sessions

“…Pre-oxygenation does enable breast cancer patients to double mean breath-hold duration, from 42 ± 2 s to 96 ± 0.6 s, 9 and a similar doubling (to 78 s) was found for patients with lung cancer. 22 But even when combining pre-oxygenation with voluntarily hyperventilation, it is not possible to achieve breath-hold durations beyond ca . 3 min in patients 23,24 because the physical effort involved also increases CO 2 production, and hence opposes inducing hypocapnia and shortens breath-hold duration.…”