title: Deep Inspiration Breath Hold-Based Radiation Therapy: A Clinical Review.
abstract: Several recent developments in linear accelerator-based radiation therapy (RT) such as fast multileaf collimators, accelerated intensity modulation paradigms like volumeric modulated arc therapy and flattening filter-free (FFF) high-dose-rate therapy have dramatically shortened the duration of treatment fractions. Deliverable photon dose distributions have approached physical complexity limits as a consequence of precise dose calculation algorithms and online 3-dimensional image guided patient positioning (image guided RT). Simultaneously, beam quality and treatment speed have continuously been improved in particle beam therapy, especially for scanned particle beams. Applying complex treatment plans with steep dose gradients requires strategies to mitigate and compensate for motion effects in general, particularly breathing motion. Intrafractional breathing-related motion results in uncertainties in dose delivery and thus in target coverage. As a consequence, generous margins have been used, which, in turn, increases exposure to organs at risk. Particle therapy, particularly with scanned beams, poses additional problems such as interplay effects and range uncertainties. Among advanced strategies to compensate breathing motion such as beam gating and tracking, deep inspiration breath hold (DIBH) gating is particularly advantageous in several respects, not only for hypofractionated, high single-dose stereotactic body RT of lung, liver, and upper abdominal lesions but also for normofractionated treatment of thoracic tumors such as lung cancer, mediastinal lymphomas, and breast cancer. This review provides an in-depth discussion of the rationale and technical implementation of DIBH gating for hypofractionated and normofractionated RT of intrathoracic and upper abdominal tumors in photon and proton RT.
authors: Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany. Electronic address: judit.boda-heggemann@umm.de.
authors: Judit
authors: J
authors: Boda-Heggemann
authors: The Institute of Cancer Research, Royal Cancer Hospital, London, UK.
authors: Antje-Christin
authors: AC
authors: Knopf
authors: Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
authors: Anna
authors: A
authors: Simeonova-Chergou
authors: Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
authors: Hansjörg
authors: H
authors: Wertz
authors: Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
authors: Florian
authors: F
authors: Stieler
authors: Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
authors: Anika
authors: A
authors: Jahnke
authors: Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
authors: Lennart
authors: L
authors: Jahnke
authors: Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
authors: Jens
authors: J
authors: Fleckenstein
authors: Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
authors: Lena
authors: L
authors: Vogel
authors: Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
authors: Anna
authors: A
authors: Arns
authors: Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
authors: Manuel
authors: M
authors: Blessing
authors: Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
authors: Frederik
authors: F
authors: Wenz
authors: Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
authors: Frank
authors: F
authors: Lohr
mesh_terms: D062485:Breath Holding; D019583:Dose Fractionation, Radiation; D005260:Female; D006321:Heart / Q000528:radiation effects; D006801:Humans; D001239:Inhalation; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D008168:Lung / Q000528:radiation effects; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D008297:Male; D009068:Movement; D061766:Proton Therapy / Q000379:methods; D000069473:Radiation Dose Hypofractionation; D011832:Radiation Injuries / Q000517:prevention & control; D011859:Radiography; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D012119:Respiration; D000069584:Unilateral Breast Neoplasms / Q000532:radiotherapy