Alternative medicine.

Adjacent chest wall can be a dose-limiting structure during ablative lung radiation. Breath-hold techniques (either deep inspiration or end expiration) are commonly used to limit tumor motion, target volume size, and radiation dose to adjacent OARs. Here’s a novel look at alternating breath-hold treatments with half delivered during deep inspiration and half during end expiration. Why? Because the adjacent chest wall moves relative to the target in each position, meaning the max doses to any one area can be reduced without reducing prescription dose. Relative to either single breath-hold technique, the alternating technique reduced median Dmax by 2-4%, D1cc by 15%, and V30Gy by 49-63%. As expected, these reductions were far more dramatic for lower lobe tumors that saw reductions in median Dmax of 44%, D1cc of 46%, and V30Gy of 98% where there was little overlap in adjacent chest wall with each breath hold techniques. | Li, Pract Radiat Oncol 2023