Deep inspiration breath-hold in stereotactic and conventional fractionated radiotherapy of lesions in the lung

The purpose of the clinical study was to evaluate lung cancer patients’ ability to perform deep inspiration breath-hold (DIBH) during CT simulation and throughout the treatment course of radiation therapy (RT). In addition, we evaluated target sizes, organs at risk sizes and doses to the respective volumes in volumetric modulated arc therapy RT plans in free breathing (FB) and DIBH. Twenty-one patients with a peripheral lesion in the lung where RT was prescribed were included. All patients underwent breath-hold training at CT and if they complied with the requirements, a CT in DIBH, in addition to CT and 4DCT in FB, were obtained. Treatment plans in FB and DIBH were generated, and dose parameters as well as volume sizes were compared. The endpoints for evaluation were patient compliance, target dose coverages and doses to the organs-at-risk. Nineteen out of 21 patients completed treatment in DIBH. This clinical study found high patient DIBH compliance in both CT simulation and treatment for lung cancer patients. A significant reduction was found in target sizes overall and for stereotactic body radiation therapy in DIBH, as well as significantly decreased doses to heart, chest wall and lungs. DIBH in RT of lung lesions is feasible, and a routine to manage intra-fractional deviation should be established upon implementation.