Continuous Positive Airway Pressure for Motion Management in Stereotactic Body Radiation Therapy to the Lung: A Controlled Pilot Study.
OBJECTIVE
To determine the effect of continuous positive airway pressure (CPAP) on tumor motion, lung volume, and dose to critical organs in patients receiving stereotactic body radiation therapy (SBRT) for lung tumors.


METHODS
After institutional review board approval in December 2013, patients with primary or secondary lung tumors referred for SBRT underwent 4-dimensional computed tomographic simulation twice: with free breathing and with CPAP. Tumor excursion was calculated by subtracting the vector of the greatest dimension of the gross tumor volume (GTV) from the internal target volume (ITV). Volumetric and dosimetric determinations were compared with the Wilcoxon signed-rank test. CPAP was used during treatment if judged beneficial.


RESULTS
CPAP was tolerated well in 10 of the 11 patients enrolled. Ten patients with 18 lesions were evaluated. The use of CPAP decreased tumor excursion by 0.5 ± 0.8 cm, 0.4 ± 0.7 cm, and 0.6 ± 0.8 cm in the superior-inferior, right-left, and anterior-posterior planes, respectively (P ≤ .02). Relative to free breathing, the mean ITV reduction was 27% (95% confidence interval [CI] 16%-39%, P<.001). CPAP significantly augmented lung volume, with a mean absolute increase of 915 ± 432 cm(3) and a relative increase of 32% (95% CI 21%-42%, P=.003), contributing to a 22% relative reduction (95% CI 13%-32%, P=.001) in mean lung dose. The use of CPAP was also associated with a relative reduction in mean heart dose by 29% (95% CI 23%-36%, P=.001).


CONCLUSIONS
In this pilot study, CPAP significantly reduced lung tumor motion compared with free breathing. The smaller ITV, the planning target volume (PTV), and the increase in total lung volume associated with CPAP contributed to a reduction in lung and heart dose. CPAP was well tolerated, reproducible, and simple to implement in the treatment room and should be evaluated further as a novel strategy for motion management in radiation therapy.
Department of Radiation Oncology, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel.
Jeffrey D
JD
Goldstein
Department of Radiation Oncology, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Yaacov R
YR
Lawrence
Department of Radiation Oncology, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel.
Sarit
S
Appel
Department of Radiation Oncology, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel.
Efrat
E
Landau
Department of Radiation Oncology, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel.
Merav A
MA
Ben-David
Department of Radiation Oncology, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel.
Tatiana
T
Rabin
Department of Radiation Oncology, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel.
Maoz
M
Benayun
Department of Radiation Oncology, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel.
Sergey
S
Dubinski
Department of Radiation Oncology, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel.
Noam
N
Weizman
Department of Radiation Oncology, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel.
Dror
D
Alezra
Department of Radiation Oncology, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel.
Hila
H
Gnessin
Department of Radiation Oncology, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel.
Adam M
AM
Goldstein
Department of Radiation Oncology, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel.
Khader
K
Baidun
Department of Pulmonary Medicine, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Michael J
MJ
Segel
Department of Pulmonary Medicine, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Nir
N
Peled
Department of Radiation Oncology, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: symonz@sheba.health.gov.il.
Zvi
Z
Symon
D000328:Adult; D000368:Aged; D016001:Confidence Intervals; D045422:Continuous Positive Airway Pressure; D005240:Feasibility Studies; D005260:Female; D056973:Four-Dimensional Computed Tomography; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009068:Movement; D010865:Pilot Projects; D016634:Radiosurgery / Q000379:methods*; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D012119:Respiration; D018709:Statistics, Nonparametric