Department of Oncology, Rigshospitalet, University of Copenhagen, Denmark.
Department of Oncology, Rigshospitalet, University of Copenhagen, Denmark.
Int J Radiat Oncol Biol Phys. 2020 Apr 1;106(5):977-984. doi: 10.1016/j.ijrobp.2019.12.025. Epub 2020 Jan 28.
Radiation therapy delivery during deep inspiration breath-hold (DIBH) reduces the irradiation of the heart and lungs and is therefore recommended for adults with mediastinal lymphoma. However, no studies have addressed the use of DIBH in children. This pilot study investigates the feasibility of and compliance with DIBH in children.
Children from the age of 5 years were recruited to a training session to assess their ability to perform DIBH. No children received radiation therapy. The children were placed in a potential radiation therapy position. The DIBH was voluntary and monitored using an optical surface system providing visual feedback. Children who performed 3 stable DIBHs of 20 seconds each and remained motionless were deemed DIBH compliant. Compliance, equipment suitability, and coaching were further assessed in a semistructured interview.
We included 33 children (18 healthy and 15 hospitalized children with cancer) with a mean age of 8.5 years (range, 5-15). A total of 28 (85%) children were DIBH compliant. Twenty children were deemed immediately DIBH compliant, and 8 were deemed conditionally DIBH compliant, as DIBH compliance was presumed with custom-made immobilization and/or additional DIBH training. Mean age of the DIBH-compliant and the non-DIBH-compliant children was 8.9 years (range, 5-15) and 6 years (range, 5-9), respectively. Only 1 of 15 hospitalized children was not DIBH compliant and only 1 of all 33 children was unable to grasp the DIBH concept. The available DIBH equipment was suitable for children, and 94% reported that they were happy with training and performing DIBH.
This pilot study demonstrated that children from the age of 5 years can potentially comply with the DIBH technique and perform stable and reproducible DIBHs suitable for radiation therapy. Custom-made immobilization and adequate training will potentially increase DIBH compliance. A prospective clinical trial (NCT03315546), investigating the dosimetric benefit of radiation therapy delivery in DIBH compared with free breathing with pediatric patients, has been initiated.
在深吸气屏气（DIBH）期间进行放射治疗可减少心脏和肺部的照射，因此推荐用于纵隔淋巴瘤的成年人。然而，尚无研究探讨 DIBH 在儿童中的应用。本研究旨在探讨儿童 DIBH 的可行性和顺应性。
招募 5 岁及以上的儿童参加培训课程，以评估他们进行 DIBH 的能力。无儿童接受放射治疗。将儿童置于潜在的放射治疗位置。DIBH 为自愿性，使用光学表面系统进行监测，提供视觉反馈。如果儿童能够完成 3 次每次 20 秒且稳定的 DIBH，并且保持静止不动，则被认为是符合 DIBH 要求的。在半结构化访谈中进一步评估了顺应性、设备适用性和指导情况。
共纳入 33 例儿童（18 例健康儿童和 15 例住院癌症儿童），平均年龄为 8.5 岁（范围，5-15 岁）。共有 28 例（85%）儿童符合 DIBH 要求。20 例儿童被认为立即符合 DIBH 要求，8 例儿童被认为是有条件的 DIBH 符合，因为使用定制的固定装置和/或额外的 DIBH 训练可以假定符合 DIBH 要求。符合 DIBH 要求和不符合 DIBH 要求的儿童的平均年龄分别为 8.9 岁（范围，5-15 岁）和 6 岁（范围，5-9 岁）。仅 15 例住院儿童中有 1 例不符合 DIBH 要求，所有 33 例儿童中有 1 例无法理解 DIBH 概念。现有的 DIBH 设备适用于儿童，94%的儿童报告他们对培训和进行 DIBH 感到满意。
本研究表明，5 岁及以上的儿童有可能符合 DIBH 技术要求，并能够进行稳定且可重复的 DIBH，适用于放射治疗。定制的固定装置和充分的培训将有可能提高 DIBH 的顺应性。目前已启动一项前瞻性临床试验（NCT03315546），旨在研究与自由呼吸相比，DIBH 中放射治疗的剂量学优势，该试验将入组儿科患者。
