Abstract
Abstract Objective: Motion management is crucial to safe and efficacious abdominal stereotactic body radiation therapy (SBRT). Expiratory breath hold (EBH) treatment is attractive as it minimizes target motion compared with other techniques; however, only a proportion of patients can perform an EBH to permit efficient treatment. We implemented a technique utilizing supplemental oxygen and mild hyperventilation in patients receiving abdominal SBRT, with the hypothesis that it may prolong EBHs and reduce treatment times. Materials and Methods: Starting in August 2020, we provided patients supplemental oxygen (50% FiO2) and encouraged mild hyperventilation at 18 breaths/min with a metronome to improve EBHs for patients undergoing abdominal SBRT. We evaluated all completed treatments with this supplemented procedure (EBHsupp) as well as historical controls treated with EBH prior to this new procedure (EBHRA, where RA signifies room air). EBH durations and treatment times were assessed. Statistical comparisons were made with chi-square test, Student t-test, and Mann-Whitney U test. Results: For 20 patients treated with SBRT via EBHsupp and 26 patients treated with SBRT via EBHRA, there were no statistical differences in baseline patient characteristics or treatment planning characteristics between the groups. The EBHsupp group had significantly increased maximum (52.8 s vs 34.5 s, P < .001) and median (24.9 s vs 18.7 s, P = .002) EBH times and required less EBH per treatment (8.9 vs 12.7, P < .001). The mean treatment time was 3 minutes less for EBHsupp compared with EBHRA (17.6 min vs 20.8 min, P = .025). Conclusion: Patients receiving supplemental oxygen and mild hyperventilation exhibited prolonged EBH time and reduced overall treatment time during abdominal SBRT. This intervention may improve individual patient breath-hold times, reduce treatment times, and increase the number of patients eligible for EBH-based abdominal SBRT.
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