Continuous positive airway pressure as an alternative to deep-inspiration breath holding for mediastinal lymphoma radiotherapy.

Abstract

PurposeThis study explored Continuous Positive Airway Pressure (CPAP) as an alternative to breath-holding (DIBH) techniques by comparing it with free-breathing (FB) in mediastinal lymphoma patients treated with optimized volumetric arc therapy (VMAT).MethodsPatients underwent computed tomography (CT) simulation in both FB and CPAP (18 cm H2O). The amount of residual respiratory motion with CPAP was assessed using 4D-CT in 27 patients. Lungs, breasts, heart, and cardiac structures were contoured and included in VMAT optimization. Maximum and mean doses were compared for all organs, and CPAP was used if beneficial. Risks of coronary artery disease (CAD) and chronic heart failure (CHF) were estimated via excess relative risk (ERR).ResultsThe study included 58 patients (22 males, 36 females; mean age 29 years) with Hodgkin (45) or large B-cell lymphoma (13). The median prescribed dose was 30 Gy (range 30-40 Gy). CPAP was well tolerated by all patients. Only nine patients (16%) had no dosimetric benefit from CPAP and were treated in FB. CPAP increased mean lung volume by 1.6 L (4460 vs 2810 cc, p ConclusionsCPAP significantly reduced radiation doses to lungs and heart, was well tolerated and easy to implement and to use also in department with high patients workload, representing a valid and reproducible alternative to DIBH in mediastinal lymphoma radiotherapy.