Prolonging deep inspiration breath-hold time to 3 min during radiotherapy, a simple solution

Vincent Vakaet, Hans Van Hulle, Max Schoepen, Els Van Caelenberg, Annick Van Greveling, Jeroen Holvoet, Chris Monten, Luc De Baerdemaeker, Wilfried De Neve, Marc Coppens, Liv Veldeman, Vincent Vakaet, Hans Van Hulle, Max Schoepen, Els Van Caelenberg, Annick Van Greveling, Jeroen Holvoet, Chris Monten, Luc De Baerdemaeker, Wilfried De Neve, Marc Coppens, Liv Veldeman

Abstract

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.

Keywords: BMI, body mass index; Breast Neoplasm; Breath-hold; DIBH, deep inspiration breath-hold; Female; FiO2, fraction of inspired oxygen; HFNO, high flow nasal oxygen; HFPV, high Frequency Percussive Ventilation; Hyperventilation; IMRT, intensity modulated radiotherapy; L-DIBH, prolonged deep inspiration breath-hold; Oxygen; Prone; RR, respiratory rate; Radiotherapy.

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

© 2021 The Authors.

Figures

Fig. 1
Fig. 1
Oxygenation methods tested during protocol development. A. High-flow nasal oxygen (Optiflow Thrive device), delivery of a heated and humidified oxygen mixture through a nasal cannula. B. Mechanical ventilator with facemask. C. Non-rebreather mask with oxygen reservoir or Hudson mask.
Fig. 2
Fig. 2
Boxplots of the L-DIBH durations during validation with 8 breast cancer patients a) according to the day of the examination or b) according to the order of L-DIBHs during each examination day. The box shows the upper and lower quartile, showing the interquartile range (IQR). The line dividing the box represents the median. The upper- and lower whiskers represent the upper and lower values within 1.5 times the IQR. The dots represent the outliers outside 1.5 times the IQR above the upper quartile and bellow the lower quartile.

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Source: PubMed

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