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Effect of continuous positive airway pressure administration during lung stereotactic ablative radiotherapy: a comparative planning study

Auswirkungen des kontinuierlichen positiven Atemwegsdrucks während der stereotaktischen ablativen Strahlentherapie: eine vergleichende Planungsstudie

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Abstract

Purpose

By increasing lung volume and decreasing respiration-induced tumour motion amplitude, administration of continuous positive airway pressure (CPAP) during stereotactic ablative radiotherapy (SABR) could allow for better sparing of the lungs and heart. In this study, we evaluated the effect of CPAP on lung volume, tumour motion amplitude and baseline shift, as well as the dosimetric impact of the strategy.

Methods

Twenty patients with lung tumours referred for SABR underwent 4D-computed tomography (CT) scans with and without CPAP (CPAP/noCPAP) at two timepoints (T0/T1). First, CPAP and noCPAP scans were compared for lung volume, tumour motion amplitude, and baseline shift. Next, CPAP and noCPAP treatment plans were computed and compared for lung dose parameters (mean lung dose (MLD), lung volume receiving 20 Gy (V20Gy), 13 Gy (V13Gy), and 5 Gy (V5Gy)) and mean heart dose (MHD).

Results

On average, CPAP increased lung volume by 8.0% (p < 0.001) and 6.3% (p < 0.001) at T0 and T1, respectively, but did not change tumour motion amplitude or baseline shift. As a result, CPAP administration led to an absolute decrease in MLD, lung V20Gy, V13Gy and V5Gy of 0.1 Gy (p = 0.1), 0.4% (p = 0.03), 0.5% (p = 0.04) and 0.5% (p = 0.2), respectively, while having no significant influence on MHD.

Conclusions

In patients referred for SABR for lung tumours, CPAP increased lung volume without modifying tumour motion or baseline shift. As a result, CPAP allowed for a slight decrease in radiation dose to the lungs, which is unlikely to be clinically significant.

Zusammenfassung

Zielsetzung

Aus der Erhöhung des Lungenvolumens und der Verringerung der atembedingten Tumorbewegungsamplitude beim Einsatz des kontinuierlichen positiven Atemwegsdrucks (CPAP „continuous positive airway pressure“) während der stereotaktischen ablativen Strahlentherapie (SABR „stereotactic ablative radiotherapy“) könnte ein erhöhter Schutz von Lunge und Herz resultieren. Diese Studie untersucht die Auswirkung der CPAP auf Lungenvolumen, Tumorbewegungsamplitude und „baseline shift“ sowie deren Einfluss auf die Dosisverteilung.

Methoden

Von 20 Patienten mit Lungentumoren, für die eine SABR indiziert ist, wurden zu zwei verschiedenen Zeitpunkten (T0/T1) 4‑D-Computertomographie-(CT-)Aufnahmen mit und ohne CPAP (CPAP/noCPAP) angefertigt. Zuerst wurden die CPAP- und noCPAP-Aufnahmen hinsichtlich Lungenvolumen, Tumorbewegungsamplitude und „baseline shift“ verglichen. Anschließend wurden CPAP- und noCPAP-Bestrahlungspläne erstellt und bezüglich der Dosisverteilung auf Herz und Lunge gegenübergestellt.

Ergebnisse

Im Durchschnitt vergrößerte CPAP das Lungenvolumen zu T0 und T1 um 8% (p < 0,001) bzw. 6,3% (p < 0,001), ohne Tumorbewegungsamplitude und „baseline shift“ zu verändern. Im Ergebnis verringerte die CPAP die mittlere Strahlendosis auf die Lunge um 0,1 Gy (p = 0,1) und die Volumenparameter V20Gy, V13Gy und V5Gy jeweils um 0,4% (p = 0,03), 0,5% (p = 0,04) und 0,5% (p = 0,2), ohne die Strahlendosis auf das Herz zu beeinflussen.

Schlussfolgerung

Bei Patienten, deren Lungentumor einer SABR unterzogen wurde, vergrößerte die CPAP das Lungenvolumen, ohne die Tumorbewegungsamplitude oder den „baseline shift“ zu beeinflussen. Infolgedessen wurde die Strahlendosis auf die Lunge leicht verringert, deren klinische Relevanz ist jedoch unwahrscheinlich.

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Acknowledgements

We would like to thank Valérie Lacroix who provided the original idea for this article and Karolin Schneider who translated the abstract into German.

Funding

This study was funded by the Fonds de la Recherche Scientifique—FNRS—Télévie (grant n°7.4572.13F) and the Fondation Contre le Cancer (grant n°2014-086).

Author information

Authors and Affiliations

  1. Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Avenue Hippocrate 54, box B1.54.07, 1200, Brussels, Belgium

    Dario Di Perri, Kevin Souris & Xavier Geets

  2. Department of Radiation Oncology, Cliniques universitaires Saint-Luc, Brussels, Belgium

    Dario Di Perri, Andréa Colot, Antoine Delor, Randa Ghoul & Xavier Geets

  3. Ion Beam Applications, Louvain-la-Neuve, Belgium

    Guillaume Janssens

  4. Department of Cardiovascular and Thoracic Surgery, Cliniques universitaires Saint-Luc, Brussels, Belgium

    Valérie Lacroix

  5. Cardiovascular Intensive Care, Cliniques universitaires Saint-Luc, Brussels, Belgium

    Pascal Matte

  6. Pole of Epidemiology and Biostatistics (EPID), Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium

    Annie Robert

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  1. Dario Di Perri
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  2. Andréa Colot
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  8. Annie Robert
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Corresponding author

Correspondence to Dario Di Perri.

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Conflict of interest

D. Di Perri, A. Colot, A. Delor, R. Ghoul, G. Janssens, V Lacroix, P. Matte, A. Robert, K. Souris and X. Geets declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (registration number of the ethical approval: B403201524475) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Di Perri, D., Colot, A., Delor, A. et al. Effect of continuous positive airway pressure administration during lung stereotactic ablative radiotherapy: a comparative planning study. Strahlenther Onkol 194, 591–599 (2018). https://doi.org/10.1007/s00066-018-1278-2

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  • DOI: https://doi.org/10.1007/s00066-018-1278-2

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