Voluntary deep inspiration breath-hold with volumetric modulated arc therapy in pediatric patients with mediastinal Hodgkin lymphoma

Abstract

Background: Deep inspiration breath-hold (DIBH) has been established to decrease normal tissue radiation dose in breast cancer. Methods: Forty-nine patients had two CT scans during DIBH or free breathing. Chest-wall position, setup verification and breath-hold monitoring were performed. Cone-beam CT and a surface image system were used for verification. Results: A total of 1617 breath-holds were analyzed in 401 fractions. The mean time bit was 6.01min. The mean breaths-holds per fraction was 4.96. The median for intra-breath hold variability was 3mm. No patient stopped treatment for intolerance. Clinical target volume margins were calculated as 0.36, 0.36and 0.32 for the three translational positions. The mean saved volume was 26.3%. Conclusion: Voluntary DIBHis feasible, tolerableand easy to apply for children with Hodgkin lymphoma involving the mediastinum.

Plain language summary

Deep inspiration breath-hold (DIBH) is a radiotherapy maneuver to decrease the exposure of normal tissues during the radiation of the target organ. It was developed for the treatment of breast cancer, both intact breast and chest wall, after mastectomy. For mediastinal Hodgkin lymphoma, especially in children and adolescents, DIBH will benefit in decreasing the radiation dose to the lungs and heart in this category of patients who still have normal growing tissues. We treated 49 pediatric and adolescent patients with DIBH and precise radiotherapy (volumetric modulated arc therapy) to augment the benefit of lowering the dose to normal tissues. All patients were trained and coached to breath-hold for more than 20s. No patient stopped treatment due to poor tolerance or discomfort. Only one breath-hold was required for CT simulation in all populations (100%). The mean number of breath-holds per treatment fraction was 5.1±1.8. The mean treatment time was 6±1.8min. DIBH is feasible, tolerable and easy to apply for children and adolescents with Hodgkin lymphoma involving the mediastinum. A considerable dose volume could be saved, hence decreasing the rate of side effects.

Keywords::

• Hodgkin lymphoma
• mediastinal lymphoma
• VMAT
• voluntary deep inspiration breath-hold

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the article. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have obtained appropriate institutional review board approval or have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations. In addition, for investigations involving human subjects, informed consent has been obtained from the participants involved.