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

Vincent Vakaet (UGent) , Hans Van Hulle (UGent) , Max Schoepen (UGent) , Els Van Caelenberg (UGent) , Annick Van Greveling (UGent) , Jeroen Holvoet (UGent) , Christel Monten (UGent) , Luc De Baerdemaeker (UGent) , Wilfried De Neve (UGent) , Marc Coppens (UGent) , et al.
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Organization
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. (C) 2021 The Authors. Published by Elsevier B.V. on behalf of European Society for Radiotherapy and Oncology.
Keywords
UK HEARTSPARE, CANCER, REPRODUCIBILITY, PRONE, IRRADIATION, POSITION, IMPROVE, MOTION, WOMEN, WHOLE, Breath-hold, Hyperventilation, Oxygen, Female, Radiotherapy, Breast Neoplasm, Prone

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MLA
Vakaet, Vincent, et al. “Prolonging Deep Inspiration Breath-Hold Time to 3 Min during Radiotherapy, a Simple Solution.” CLINICAL AND TRANSLATIONAL RADIATION ONCOLOGY, vol. 28, 2021, pp. 10–16, doi:10.1016/j.ctro.2021.02.007.
APA
Vakaet, V., Van Hulle, H., Schoepen, M., Van Caelenberg, E., Van Greveling, A., Holvoet, J., … Veldeman, L. (2021). Prolonging deep inspiration breath-hold time to 3 min during radiotherapy, a simple solution. CLINICAL AND TRANSLATIONAL RADIATION ONCOLOGY, 28, 10–16. https://doi.org/10.1016/j.ctro.2021.02.007
Chicago author-date
Vakaet, Vincent, Hans Van Hulle, Max Schoepen, Els Van Caelenberg, Annick Van Greveling, Jeroen Holvoet, Christel Monten, et al. 2021. “Prolonging Deep Inspiration Breath-Hold Time to 3 Min during Radiotherapy, a Simple Solution.” CLINICAL AND TRANSLATIONAL RADIATION ONCOLOGY 28: 10–16. https://doi.org/10.1016/j.ctro.2021.02.007.
Chicago author-date (all authors)
Vakaet, Vincent, Hans Van Hulle, Max Schoepen, Els Van Caelenberg, Annick Van Greveling, Jeroen Holvoet, Christel Monten, Luc De Baerdemaeker, Wilfried De Neve, Marc Coppens, and Liv Veldeman. 2021. “Prolonging Deep Inspiration Breath-Hold Time to 3 Min during Radiotherapy, a Simple Solution.” CLINICAL AND TRANSLATIONAL RADIATION ONCOLOGY 28: 10–16. doi:10.1016/j.ctro.2021.02.007.
Vancouver
1.
Vakaet V, Van Hulle H, Schoepen M, Van Caelenberg E, Van Greveling A, Holvoet J, et al. Prolonging deep inspiration breath-hold time to 3 min during radiotherapy, a simple solution. CLINICAL AND TRANSLATIONAL RADIATION ONCOLOGY. 2021;28:10–6.
IEEE
[1]
V. Vakaet et al., “Prolonging deep inspiration breath-hold time to 3 min during radiotherapy, a simple solution,” CLINICAL AND TRANSLATIONAL RADIATION ONCOLOGY, vol. 28, pp. 10–16, 2021.
@article{8698423,
  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. (C) 2021 The Authors. Published by Elsevier B.V. on behalf of European Society for Radiotherapy and Oncology.}},
  author       = {{Vakaet, Vincent and Van Hulle, Hans and Schoepen, Max and Van Caelenberg, Els and Van Greveling, Annick and Holvoet, Jeroen and Monten, Christel and De Baerdemaeker, Luc and De Neve, Wilfried and Coppens, Marc and Veldeman, Liv}},
  issn         = {{2405-6308}},
  journal      = {{CLINICAL AND TRANSLATIONAL RADIATION ONCOLOGY}},
  keywords     = {{UK HEARTSPARE,CANCER,REPRODUCIBILITY,PRONE,IRRADIATION,POSITION,IMPROVE,MOTION,WOMEN,WHOLE,Breath-hold,Hyperventilation,Oxygen,Female,Radiotherapy,Breast Neoplasm,Prone}},
  language     = {{eng}},
  pages        = {{10--16}},
  title        = {{Prolonging deep inspiration breath-hold time to 3 min during radiotherapy, a simple solution}},
  url          = {{http://dx.doi.org/10.1016/j.ctro.2021.02.007}},
  volume       = {{28}},
  year         = {{2021}},
}

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