Mechanically-assisted non-invasive deep inspiration breath-hold (MANIV-DIBH): A first clinical application in paediatric radiotherapy.

Abstract

Background and purposeRespiratory motion is a major challenge in paediatric thoracic radiotherapy, where minimizing exposure to healthy tissues is essential to reduce long-term toxicity. Mechanically-assisted non-invasive ventilation deep inspiration breath-hold (MANIV-DIBH) allows non-sedated patients to achieve repeated, reproducible breath-holds, potentially reducing safety margins and improving dose conformity. We report the first paediatric application of this technique during whole lung irradiation (WLI).Material and methodsA 10-year-old girl with metastatic Ewing sarcoma was referred for WLI. A preparatory session with a physiotherapist was performed to introduce MANIV-DIBH with child-adapted communication and select the optimal non-vented oronasal mask. Ventilator settings for assisted breath-holds were tailored to the patient's tolerance. The goal was to achieve multiple 20-s breath-holds. The simulation CT was acquired during MANIV-DIBH. WLI (15 Gy in 10 fractions) was planned with IMRT.ResultsThe patient performed stable and reproducible 20-s breath-holds across 10 sessions, with an average fraction time of 32.1 (±7.8) minutes. Treatment was well tolerated, with grade 2 fatigue. Follow-up PET/CT showed complete response and no imaging signs of toxicity.ConclusionThis first paediatric clinical application of MANIV-DIBH suggests feasibility, stability, and good tolerability. Its successful use required careful, multidisciplinary implementation and adaptation to the paediatric setting. These preliminary findings support further evaluation in this population.