ArticleThe British journal of radiology2024
Clinical implementation and evaluation of stereotactic liver radiotherapy in inspiration breath-hold using nasal high-flow therapy and surface guidance.
Article in The British journal of radiology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo evaluate 2 years of clinical experience with markerless breath-hold liver stereotactic radiotherapy (SBRT) using noninvasive nasal high-flow therapy (NHFT) for breath-hold prolonging and surface guidance (SGRT) for monitoring.
methodsHeated and humidified air was administered via a nasal cannula (40 L/min, 80% oxygen, 34 °C). Patients performed voluntary inspiration breath-holds with visual feedback. After a training session, 4-5 breath-hold CT scans were acquired to delineate an internal target volume (ITV) accounting for inter- and intra-breath-hold variations. Patients were treated in 3-8 fractions (7.5-20 Gy/fraction) using SGRT-controlled beam-hold. Patient setup was performed using SGRT and CBCT imaging. A posttreatment CBCT was acquired for evaluation purposes.
resultsFifteen patients started the training session and received treatment, of whom 10 completed treatment in breath-hold. Half of all 60-second CBCT scans were acquired during a single breath-hold. The average maximum breath-hold duration during treatment ranged from 47 to 108 s. Breath-hold ITV was on average 6.5 cm³/30% larger (range: 1.1-23.9 cm³/5%-95%) than the largest GTV. Free-breathing ITV based on 4DCT scans was on average 16.9 cm³/47% larger (range: -2.3 to 58.7 cm3/-16% to 157%) than the breath-hold ITV. The average 3D displacement vector of the area around PTV for the posttreatment CBCT scans was 5.0 mm (range: 0.7-12.9 mm).
conclusionsLiver SBRT in breath-hold using NHFT and SGRT is feasible for the majority of patients. An ITV reduction was observed compared to free-breathing treatments. To further decrease the PTV, internal anatomy-based breath-hold monitoring is desired. ADVANCES IN KNOWLEDGE: Noninvasive NHFT allows for prolonged breath-holding during surface-guided liver SBRT.
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