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Objectives <p>To determine the impact of continuous positive airway pressure (CPAP) breathing on organ at risk (OAR) sparing in synchronous bilateral breast cancer (SBBC) radiotherapy.</p> Materials and methods <p>Patients with SBBC planned for adjuvant bilateral irradiation were prospectively enrolled in this study. Patients first underwent a free breathing (FB) planning computed tomography (CT). They were trained to breath with CPAP device for 30&#xa0;min under a maximum tolerable pressure of 10-15cmH<sub>2</sub>O. A second planning CT was then performed under CPAP breathing. Heart substructures, including the left ventricle (LV) and left anterior descending artery (LAD) were contoured on both FB and CPAP planning CTs. Treatment plans were generated for both CTs using a 3D conformal technique with a prescription dose of 40.05&#xa0;Gy/15 fractions +/- an additional boost of 10&#xa0;Gy. Using the coordinates of the heart’s centre of mass on both CTs, we performed a vector analysis to assess heart’s displacement with CPAP breathing. Based on both anatomic and dosimetric criteria, FB and CPAP plans were statistically compared, using the t student test.</p> Results <p>A total of 40 SBBC patients were included in this study. All patient successfully completed the simulation procedure. CPAP breathing yielded significant lungs expansion (+ 46.5%), and subsequently displaced the heart inferiorly and medially. Heart volume within tangential fields was reduced by 72% with CPAP breathing (<i>p</i> = 0.00). Favourable physical changes induced by CPAP breathing resulted in significant reduction of all dose metrics to the heart, LV, LAD and lung. MHD was reduced by 32% (<i>p</i> = 0.005). Dose reduction to cardiac subvolumes reached − 66% and − 64% respectively for V35.3&#xa0;Gy LAD and V20.3&#xa0;Gy LV.</p> Conclusion <p>CPAP offered significant cardiac and lung dose reductions in SBBC radiotherapy. These findings support CPAP as an accessible and efficient heart-sparing technique, particularly in clinical settings where deep inspiration breath hold is unavailable or unfeasible.</p>

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Two breasts, one breath: continuous positive airway pressure for innovative heart sparing in synchronous bilateral breast cancer radiotherapy

  • 期刊论文

  • 发表日期：

    2025年12月4日

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  • Zeineb Naimi,
  • Amal Riahi,
  • Azza Slim,
  • Raouia Ben Amor,
  • Awatef Hamdoun,
  • Raja Oueslati,
  • Roua Toumi,
  • Rihab Haddad,
  • Ghada Bouguerra,
  • Hafaoua Daghfous,
  • Lilia Ghorbel,
  • Lotfi Kochbati

摘要

Objectives

To determine the impact of continuous positive airway pressure (CPAP) breathing on organ at risk (OAR) sparing in synchronous bilateral breast cancer (SBBC) radiotherapy.

Materials and methods

Patients with SBBC planned for adjuvant bilateral irradiation were prospectively enrolled in this study. Patients first underwent a free breathing (FB) planning computed tomography (CT). They were trained to breath with CPAP device for 30 min under a maximum tolerable pressure of 10-15cmH2O. A second planning CT was then performed under CPAP breathing. Heart substructures, including the left ventricle (LV) and left anterior descending artery (LAD) were contoured on both FB and CPAP planning CTs. Treatment plans were generated for both CTs using a 3D conformal technique with a prescription dose of 40.05 Gy/15 fractions +/- an additional boost of 10 Gy. Using the coordinates of the heart’s centre of mass on both CTs, we performed a vector analysis to assess heart’s displacement with CPAP breathing. Based on both anatomic and dosimetric criteria, FB and CPAP plans were statistically compared, using the t student test.

Results

A total of 40 SBBC patients were included in this study. All patient successfully completed the simulation procedure. CPAP breathing yielded significant lungs expansion (+ 46.5%), and subsequently displaced the heart inferiorly and medially. Heart volume within tangential fields was reduced by 72% with CPAP breathing (p = 0.00). Favourable physical changes induced by CPAP breathing resulted in significant reduction of all dose metrics to the heart, LV, LAD and lung. MHD was reduced by 32% (p = 0.005). Dose reduction to cardiac subvolumes reached − 66% and − 64% respectively for V35.3 Gy LAD and V20.3 Gy LV.

Conclusion

CPAP offered significant cardiac and lung dose reductions in SBBC radiotherapy. These findings support CPAP as an accessible and efficient heart-sparing technique, particularly in clinical settings where deep inspiration breath hold is unavailable or unfeasible.