Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Cancer Radiother. 2023 Feb;27(1):23-30. doi: 10.1016/j.canrad.2022.05.001. Epub 2022 Aug 31.
Continuous positive airway pressure (CPAP) ventilation hyperinflates the lungs and reduces diaphragmatic motion. We hypothesized that CPAP could be safely combined with deep inspiratory breath hold (CPAP-DIBH) during lung stereotactic radiotherapy (SBRT).
Patients with stage-1 lung cancer or lung metastasis treated with CPAP-DIBH SBRT between 3/2017-5/2021 were analyzed retrospectively. Patient characteristics, treatment parameters, duration of breath holds in all sessions and tolerance to CPAP-DIBH were recorded. Local control (LC) was assessed from CT or PET-CT imaging. The distances between the tumor and mediastinal organs at risk (OAR) in centrally located tumors using either free breathing (FB) or CPAP-DIBH were compared. Toxicity was graded retrospectively.
Forty-five patients with 71 lesions were treated with CPAP-DIBH SBRT. Indications for CPAP-DIBH were prior radiation (35/71, 65%), lower lobe location (34/71, 48%), multiple lesions (26/71, 36.6%) and proximity to mediastinal OAR (7/71, 10%). Patient characteristics were: F:M 43%: 57%; mean gross tumor volume 4.5cm (SD 7.9), mean planning target volume 20cm (SD 27), primary: metastatic lesions (7%:93%). Mean radiation dose was 52.5 Gray (SD3.5). Mean lung volume was 5292cm (SD 1106). Mean duration of CPAP-DIBH was 41.3s (IQR 31-46.8). LC at 2 years was 89.5% (95% CI 76-95.5). In patients with central lesions, the distance between the tumor and mediastinal OAR increased from 0.84cm (SD 0.65) with FB to 1.23cm (SD 0.8) with CPAP-DIBH (p=0.002). Most patients tolerated CPAP well and completed all treatments after starting therapy. Three patients did not receive treatment: 2 were unable to tolerate CPAP and 1 had syncope (pre-existing). Toxicity was grade 2 in 4/65 (6%) and grade 3 in 1/65 (1.5%). There was no grade 2 or higher esophageal or tracheal toxicities.
CPAP-DIBH assisted lung SBRT was tolerated well and was associated with minimal toxicity and favorable LC. This technique may be considered when treating multiple lung lesions, lesions located in the lower lobes or adjacent to mediastinal OAR.
持续气道正压通气（CPAP）会使肺部过度充气并减少膈肌运动。我们假设 CPAP 可以在肺部立体定向放疗（SBRT）期间与深吸气屏气（CPAP-DIBH）安全结合。
回顾性分析了 2017 年 3 月至 2021 年 5 月期间接受 CPAP-DIBH SBRT 治疗的 1 期肺癌或肺转移患者。记录患者特征、治疗参数、所有疗程中的屏气时间以及对 CPAP-DIBH 的耐受情况。通过 CT 或 PET-CT 影像学评估局部控制（LC）。比较中央位置肿瘤使用自由呼吸（FB）或 CPAP-DIBH 时肿瘤与纵隔危险器官（OAR）之间的距离。回顾性分级毒性。
45 例 71 个病灶接受 CPAP-DIBH SBRT 治疗。CPAP-DIBH 的适应证为既往放疗（35/71，65%）、下叶病变（34/71，48%）、多发病灶（26/71，36.6%）和靠近纵隔 OAR（7/71，10%）。患者特征为：F：M 43%：57%；大体肿瘤体积平均 4.5cm（SD 7.9），计划靶区平均 20cm（SD 27），原发性：转移性病变（7%：93%）。平均照射剂量为 52.5 格雷（SD3.5）。平均肺体积为 5292cm（SD 1106）。CPAP-DIBH 的平均持续时间为 41.3s（IQR 31-46.8）。2 年 LC 率为 89.5%（95%CI 76-95.5）。在中央病变患者中，肿瘤与纵隔 OAR 之间的距离从 FB 时的 0.84cm（SD 0.65）增加到 CPAP-DIBH 时的 1.23cm（SD 0.8）（p=0.002）。大多数患者耐受 CPAP 良好，并在开始治疗后完成了所有治疗。有 3 名患者未接受治疗：2 名无法耐受 CPAP，1 名出现晕厥（既往存在）。毒性为 65 例中的 4 例（6%）为 2 级，1 例（1.5%）为 3 级。无 2 级或更高级别的食管或气管毒性。
CPAP-DIBH 辅助肺部 SBRT 耐受良好，且毒性最小，LC 结果良好。在治疗多个肺部病变、下叶病变或邻近纵隔 OAR 时，可以考虑使用这种技术。
