Noninvasive Mechanical Ventilation Is a Promising Way to Improve Lung Cancer Radiation Therapy

IF 2.2 Q3 ONCOLOGY Advances in Radiation Oncology Pub Date : 2025-02-01 DOI:10.1016/j.adro.2024.101679
Johannes K. Veldman-Landegent MS , Zdenko van Kesteren PhD , Mike J. Parkes PhD , Markus F. Stevens MD PhD , Joost G. van den Aardweg MD, PhD , Edith M.T. Dieleman MD , Eva Versteijne MD, PhD , Geertjan van Tienhoven MD, PhD , Arjan Bel PhD , Irma W.E.M. van Dijk PhD
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Abstract

Purpose

Accurate radiation therapy (RT) for lung cancer is challenging because of the respiratory motion of the tumor and surrounding organs at risk. Recently, non-invasive mechanical ventilation (NIMV) has been investigated as a novel respiratory motion management strategy. Using NIMV, respiratory motion can be minimized, while a larger lung volume yields less overall lung dose. The purpose of this study was to determine the potential benefit of NIMV to improve lung cancer RT using magnetic resonance imaging (MRI) data of healthy volunteers.

Methods and Materials

Twelve healthy volunteers practiced NIMV at 60 breaths per minute (NIMV60) with added positive end-expiratory pressure (PEEP) in 2 sessions and subsequently underwent NIMV60 in 2 MRI sessions. We acquired single-slice sagittal 2-dimensional MRI images at 2.6 Hz for 6 minutes during free breathing and NIMV60. We quantified the motion of all visible cross-sections of lung arteries, as a surrogate for lung tumors, in cranio-caudal and anterior-posterior directions using deformable image registration, distinguishing between 4 quadrants in the lungs (posterior-cranial, posterior-caudal, anterior-caudal, and anterior-cranial). Also, we analyzed average lung area, as a surrogate for lung volume, on the sagittal images using automatic segmentation.

Results

All volunteers were successfully trained to be ventilated with NIMV60, and completed all sessions. The reduction of the median lung artery motion in each of the quadrants varied from 61% to 67% (from 10.7-29.9 to 3.8-11.7 mm) in cranio-caudal direction and from 51% to 68% (from 8.0-13.7 to 3.0-5.1 mm) in anterior-posterior direction using NIMV60. NIMV60 increased the sagittal lung area by 35% compared with free breathing.

Conclusions

NIMV60 with added PEEP is a promising way to improve lung cancer RT because of reduced respiratory motion and increased lung area compared with free breathing.
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无创机械通气是改善肺癌放射治疗的有效途径
目的:肺癌的精确放射治疗(RT)具有挑战性,因为肿瘤和周围器官的呼吸运动处于危险之中。近年来,无创机械通气(NIMV)作为一种新的呼吸运动管理策略被研究。使用NIMV,可以最大限度地减少呼吸运动,而更大的肺容量意味着更少的总肺剂量。本研究的目的是利用健康志愿者的磁共振成像(MRI)数据确定NIMV改善肺癌RT的潜在益处。方法和材料:12名健康志愿者在2次呼气末正压(PEEP)下以每分钟60次呼吸(NIMV60)的速度练习NIMV,随后在2次MRI检查中进行NIMV60。我们在自由呼吸和NIMV60下获得2.6 Hz、6分钟的单层矢状二维MRI图像。我们量化了所有可见的肺动脉横截面的运动,作为肺肿瘤的替代物,在颅尾和前后方向上使用可变形图像配准,区分肺的4个象限(颅后、后尾端、前尾端和前颅)。此外,我们分析了平均肺面积,作为肺体积的替代品,在矢状图像上使用自动分割。结果:所有志愿者均成功接受NIMV60通气训练,并完成所有训练。使用NIMV60后,每个象限的肺正中动脉运动减少量在颅尾方向为61% ~ 67%(从10.7 ~ 29.9 mm到3.8 ~ 11.7 mm),在前后方向为51% ~ 68%(从8.0 ~ 13.7 mm到3.0 ~ 5.1 mm)。与自由呼吸相比,NIMV60使矢状肺面积增加35%。结论:与自由呼吸相比,增加PEEP的NIMV60可减少呼吸运动,增加肺面积,是改善肺癌RT的一种有希望的方法。
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来源期刊
Advances in Radiation Oncology
Advances in Radiation Oncology Medicine-Radiology, Nuclear Medicine and Imaging
CiteScore
4.60
自引率
4.30%
发文量
208
审稿时长
98 days
期刊介绍: The purpose of Advances is to provide information for clinicians who use radiation therapy by publishing: Clinical trial reports and reanalyses. Basic science original reports. Manuscripts examining health services research, comparative and cost effectiveness research, and systematic reviews. Case reports documenting unusual problems and solutions. High quality multi and single institutional series, as well as other novel retrospective hypothesis generating series. Timely critical reviews on important topics in radiation oncology, such as side effects. Articles reporting the natural history of disease and patterns of failure, particularly as they relate to treatment volume delineation. Articles on safety and quality in radiation therapy. Essays on clinical experience. Articles on practice transformation in radiation oncology, in particular: Aspects of health policy that may impact the future practice of radiation oncology. How information technology, such as data analytics and systems innovations, will change radiation oncology practice. Articles on imaging as they relate to radiation therapy treatment.
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