Visually guided inspiration breath-hold facilitated with nasal high flow therapy in locally advanced lung cancer

Stephanie T. H. Peeters*, Femke Vaassen, Colien Hazelaar, Ana Vaniqui, Eva Rousch, Debby Tissen, Esther Van Enckevort, Michiel De Wolf, Michel C. Ollers, Wouter van Elmpt, Karolien Verhoeven, Judith G. M. Van Loon, Bettine A. Vosse, Dirk K. M. De Ruysscher, Gloria Vilches-Freixas

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Background and purpose

Reducing breathing motion in radiotherapy (RT) is an attractive strategy to reduce margins and better spare normal tissues. The objective of this prospective study (NCT03729661) was to investigate the feasibility of irradiation of non-small cell lung cancer (NSCLC) with visually guided moderate deep inspiration breath-hold (IBH) using nasal high-flow therapy (NHFT).

Material and methods

Locally advanced NSCLC patients undergoing photon RT were given NHFT with heated humidified air (flow: 40 L/min with 80% oxygen) through a nasal cannula. IBH was monitored by optical surface tracking (OST) with visual feedback. At a training session, patients had to hold their breath as long as possible, without and with NHFT. For the daily cone beam CT (CBCT) and RT treatment in IBH, patients were instructed to keep their BH as long as it felt comfortable. OST was used to analyze stability and reproducibility of the BH, and CBCT to analyze daily tumor position. Subjective tolerance was measured with a questionnaire at 3 time points.


Of 10 included patients, 9 were treated with RT. Seven (78%) completed the treatment with NHFT as planned. At the training session, the mean BH length without NHFT was 39 s (range 15-86 s), and with NHFT 78 s (range 29-223 s) (p = .005). NHFT prolonged the BH duration by a mean factor of 2.1 (range 1.1-3.9s). The mean overall stability and reproducibility were within 1 mm. Subjective tolerance was very good with the majority of patients having no or minor discomfort caused by the devices. The mean inter-fraction tumor position variability was 1.8 mm (-1.1-8.1 mm;SD 2.4 mm).


NHFT for RT treatment of NSCLC in BH is feasible, well tolerated and significantly increases the breath-hold duration. Visually guided BH with OST is stable and reproducible. We therefore consider this an attractive patient-friendly approach to treat lung cancer patients with RT in BH.

Original languageEnglish
Pages (from-to)567-574
Number of pages8
JournalActa Oncologica
Issue number5
Early online date27 Nov 2020
Publication statusPublished - 4 May 2021


  • Lung cancer
  • breath hold
  • radiotherapy
  • surface scanning


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