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The Capital Region of Denmark - a part of Copenhagen University Hospital
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Deep inspiration breath hold in locally advanced lung cancer radiotherapy: validation of intrafractional geometric uncertainties in the INHALE trial

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OBJECTIVES: Patients with locally advanced non-small cell lung cancer (NSCLC) were included in a prospective trial for radiotherapy in deep inspiration breath hold (DIBH). We evaluated DIBH compliance and target position reproducibility.

METHODS: Voluntary, visually guided DIBHs were performed with optical tracking. Patients underwent three consecutive DIBH CT scans for radiotherapy planning. We evaluated the intrafractional uncertainties in the position of the peripheral tumour, lymph nodes and differential motion between them, enabling PTV margins calculation. Patients who underwent all DIBH imaging and had tumour position reproducibility <8 mm were up-front DIBH compliant. Patients who performed DIBHs throughout the treatment course were overall DIBH compliant. Clinical parameters and DIBH-related uncertainties were validated against our earlier pilot study.

RESULTS: 69 of 88 included patients received definitive radiotherapy. 60/69 patients (87%) were up-front DIBH compliant. DIBH plan was not superior in seven patients and three lost DIBH ability during the treatment, leaving 50/69 patients (72%) overall DIBH compliant.The systematic and random errors between consecutive DIBHs were small but differed from the pilot study findings. This led to slightly different PTV margins between the two studies.

CONCLUSIONS: DIBH compliance and reproducibility was high. Still, this validation study highlighted the necessity of designing PTV margins in larger, representative patient cohorts.

ADVANCES IN KNOWLEDGE: We demonstrated high DIBH compliance in locally advanced NSCLC patients. DIBH does not eliminate but mitigates the target position uncertainty, which needs to be accounted for in treatment margins. Margin design should be based on data from larger representative patient groups.

Original languageEnglish
JournalThe British journal of radiology
Volume92
Issue number1104
Pages (from-to)20190569
ISSN0007-1285
DOIs
Publication statusPublished - Dec 2019

    Research areas

  • Aged, Aged, 80 and over, Breath Holding, Carcinoma, Non-Small-Cell Lung/diagnostic imaging, Female, Humans, Inhalation, Lung Neoplasms/diagnostic imaging, Lymph Nodes/diagnostic imaging, Male, Middle Aged, Organ Motion, Pilot Projects, Positron Emission Tomography Computed Tomography, Prospective Studies, Radiotherapy Planning, Computer-Assisted/methods, Reproducibility of Results, Uncertainty

ID: 58931018