Feasibility and tolerability of breath-hold in liver stereotactic body radiotherapy with surface guided radiotherapy

Purpose

Intrafractional motion constitutes a significant challenge in SBRT (Stereotactic Body Radiotherapy).The breath-hold (BH) technique is employed to mitigate tumor motion; however, ensuring reproducibility and consistency remains critically important. Surface tracking systems, integrated into the treatment process, facilitate motion tracking through three-dimensional camera technology. Surface guidance has been incorporated with Varian EDGE (Varian Medical Systems, Palo Alto, CA, USA) and has been utilized at multiple treatment sites within our department since 2018. Drawing on four years of experience, this study aims to publish patient experience, assess the feasibility, and evaluate the tolerability of breath-hold during SBRT with surface guided radiotherapy (SGRT), particularly focusing on a specific subgroup: patients with liver metastases.

Methods

Prospective evaluation was conducted on patients with liver metastases undergoing breath-hold SBRT with SGRT. A two-step survey consisting of seven questions was administered after CT simulation and treatment. Treatment duration and the number of breath-holds were recorded. Additionally, factors potentially influencing SGRT and treatment time were assessed.

Results

Between April 2021 and May 2022, a total of 41 patients underwent 171 fractions of treatment. According to the questionnaire, prior training was found to be beneficial, and breath-holding during the procedure was tolerable. Patients reported experiencing slight stress due to their active participation in the treatment. Factors such as Karnofsky Performance Status (KPS), age, lung volume, conditions affecting lung capacity, previous breath-hold history, and being a native speaker showed no correlation with treatment time. Moreover, these factors did not correlate with the tolerability of breath-hold during SGRT. However, female patients showed better breath-holding performance in SGRT treatments compared to male patients (p: 0.02).

Conclusions

The application of breath-hold with SGRT procedures is tolerable and feasible in liver SBRT treatments. There exists no specific subgroup that cannot tolerate this method.