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Title: Continuous Positive Airway Pressure for Motion Management in Stereotactic Body Radiation Therapy to the Lung: A Controlled Pilot Study

Abstract

Objective: To determine the effect of continuous positive airway pressure (CPAP) on tumor motion, lung volume, and dose to critical organs in patients receiving stereotactic body radiation therapy (SBRT) for lung tumors. Methods and Materials: After institutional review board approval in December 2013, patients with primary or secondary lung tumors referred for SBRT underwent 4-dimensional computed tomographic simulation twice: with free breathing and with CPAP. Tumor excursion was calculated by subtracting the vector of the greatest dimension of the gross tumor volume (GTV) from the internal target volume (ITV). Volumetric and dosimetric determinations were compared with the Wilcoxon signed-rank test. CPAP was used during treatment if judged beneficial. Results: CPAP was tolerated well in 10 of the 11 patients enrolled. Ten patients with 18 lesions were evaluated. The use of CPAP decreased tumor excursion by 0.5 ± 0.8 cm, 0.4 ± 0.7 cm, and 0.6 ± 0.8 cm in the superior–inferior, right–left, and anterior–posterior planes, respectively (P≤.02). Relative to free breathing, the mean ITV reduction was 27% (95% confidence interval [CI] 16%-39%, P<.001). CPAP significantly augmented lung volume, with a mean absolute increase of 915 ± 432 cm{sup 3} and a relative increase of 32% (95% CI 21%-42%, P=.003), contributing to a 22% relative reduction (95% CI 13%-32%, P=.001) in mean lungmore » dose. The use of CPAP was also associated with a relative reduction in mean heart dose by 29% (95% CI 23%-36%, P=.001). Conclusion: In this pilot study, CPAP significantly reduced lung tumor motion compared with free breathing. The smaller ITV, the planning target volume (PTV), and the increase in total lung volume associated with CPAP contributed to a reduction in lung and heart dose. CPAP was well tolerated, reproducible, and simple to implement in the treatment room and should be evaluated further as a novel strategy for motion management in radiation therapy.« less

Authors:
 [1];  [1];  [2]; ; ; ; ; ; ; ; ; ; ;  [1]; ;  [3];  [2];  [1];  [2]
  1. Department of Radiation Oncology, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv (Israel)
  2. (Israel)
  3. Department of Pulmonary Medicine, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv (Israel)
Publication Date:
OSTI Identifier:
22458787
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 93; Journal Issue: 2; Other Information: Copyright (c) 2015 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; COMPARATIVE EVALUATIONS; CRITICAL ORGANS; HEART; LUNGS; NEOPLASMS; PATIENTS; PLANNING; RADIATION DOSES; RADIOTHERAPY; RESPIRATION; REVIEWS; SIMULATION

Citation Formats

Goldstein, Jeffrey D., Lawrence, Yaacov R., Sackler School of Medicine, Tel Aviv University, Tel Aviv, Appel, Sarit, Landau, Efrat, Ben-David, Merav A., Rabin, Tatiana, Benayun, Maoz, Dubinski, Sergey, Weizman, Noam, Alezra, Dror, Gnessin, Hila, Goldstein, Adam M., Baidun, Khader, Segel, Michael J., Peled, Nir, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Symon, Zvi, E-mail: symonz@sheba.health.gov.il, and Sackler School of Medicine, Tel Aviv University, Tel Aviv. Continuous Positive Airway Pressure for Motion Management in Stereotactic Body Radiation Therapy to the Lung: A Controlled Pilot Study. United States: N. p., 2015. Web. doi:10.1016/J.IJROBP.2015.06.011.
Goldstein, Jeffrey D., Lawrence, Yaacov R., Sackler School of Medicine, Tel Aviv University, Tel Aviv, Appel, Sarit, Landau, Efrat, Ben-David, Merav A., Rabin, Tatiana, Benayun, Maoz, Dubinski, Sergey, Weizman, Noam, Alezra, Dror, Gnessin, Hila, Goldstein, Adam M., Baidun, Khader, Segel, Michael J., Peled, Nir, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Symon, Zvi, E-mail: symonz@sheba.health.gov.il, & Sackler School of Medicine, Tel Aviv University, Tel Aviv. Continuous Positive Airway Pressure for Motion Management in Stereotactic Body Radiation Therapy to the Lung: A Controlled Pilot Study. United States. doi:10.1016/J.IJROBP.2015.06.011.
Goldstein, Jeffrey D., Lawrence, Yaacov R., Sackler School of Medicine, Tel Aviv University, Tel Aviv, Appel, Sarit, Landau, Efrat, Ben-David, Merav A., Rabin, Tatiana, Benayun, Maoz, Dubinski, Sergey, Weizman, Noam, Alezra, Dror, Gnessin, Hila, Goldstein, Adam M., Baidun, Khader, Segel, Michael J., Peled, Nir, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Symon, Zvi, E-mail: symonz@sheba.health.gov.il, and Sackler School of Medicine, Tel Aviv University, Tel Aviv. Thu . "Continuous Positive Airway Pressure for Motion Management in Stereotactic Body Radiation Therapy to the Lung: A Controlled Pilot Study". United States. doi:10.1016/J.IJROBP.2015.06.011.
@article{osti_22458787,
title = {Continuous Positive Airway Pressure for Motion Management in Stereotactic Body Radiation Therapy to the Lung: A Controlled Pilot Study},
author = {Goldstein, Jeffrey D. and Lawrence, Yaacov R. and Sackler School of Medicine, Tel Aviv University, Tel Aviv and Appel, Sarit and Landau, Efrat and Ben-David, Merav A. and Rabin, Tatiana and Benayun, Maoz and Dubinski, Sergey and Weizman, Noam and Alezra, Dror and Gnessin, Hila and Goldstein, Adam M. and Baidun, Khader and Segel, Michael J. and Peled, Nir and Sackler School of Medicine, Tel Aviv University, Tel Aviv and Symon, Zvi, E-mail: symonz@sheba.health.gov.il and Sackler School of Medicine, Tel Aviv University, Tel Aviv},
abstractNote = {Objective: To determine the effect of continuous positive airway pressure (CPAP) on tumor motion, lung volume, and dose to critical organs in patients receiving stereotactic body radiation therapy (SBRT) for lung tumors. Methods and Materials: After institutional review board approval in December 2013, patients with primary or secondary lung tumors referred for SBRT underwent 4-dimensional computed tomographic simulation twice: with free breathing and with CPAP. Tumor excursion was calculated by subtracting the vector of the greatest dimension of the gross tumor volume (GTV) from the internal target volume (ITV). Volumetric and dosimetric determinations were compared with the Wilcoxon signed-rank test. CPAP was used during treatment if judged beneficial. Results: CPAP was tolerated well in 10 of the 11 patients enrolled. Ten patients with 18 lesions were evaluated. The use of CPAP decreased tumor excursion by 0.5 ± 0.8 cm, 0.4 ± 0.7 cm, and 0.6 ± 0.8 cm in the superior–inferior, right–left, and anterior–posterior planes, respectively (P≤.02). Relative to free breathing, the mean ITV reduction was 27% (95% confidence interval [CI] 16%-39%, P<.001). CPAP significantly augmented lung volume, with a mean absolute increase of 915 ± 432 cm{sup 3} and a relative increase of 32% (95% CI 21%-42%, P=.003), contributing to a 22% relative reduction (95% CI 13%-32%, P=.001) in mean lung dose. The use of CPAP was also associated with a relative reduction in mean heart dose by 29% (95% CI 23%-36%, P=.001). Conclusion: In this pilot study, CPAP significantly reduced lung tumor motion compared with free breathing. The smaller ITV, the planning target volume (PTV), and the increase in total lung volume associated with CPAP contributed to a reduction in lung and heart dose. CPAP was well tolerated, reproducible, and simple to implement in the treatment room and should be evaluated further as a novel strategy for motion management in radiation therapy.},
doi = {10.1016/J.IJROBP.2015.06.011},
journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 2,
volume = 93,
place = {United States},
year = {2015},
month = {10}
}