S268
Clinical - Breast
ESTRO 2026
Digital Poster Highlight 2177 Prolonging breath-hold duration in radiotherapy using cognitive engagement Vincent Huybrechts 1,2 , Renée De Noyette 2 , Vincent Vakaet 2 , Chris Monten 1,2 , Marc Coppens 3,4 , Liv Veldeman 1,2 1 Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium. 2 Department of Human Structure and Repair, Ghent University, Ghent, Belgium. 3 Department of Anaesthesia, Ghent University Hospital, Ghent, Belgium. 4 Department of Basic and Applied Medical Sciences, Ghent University, Ghent, Belgium Purpose/Objective: Deep Inspiration Breath-Hold (DIBH) is commonly used in breast cancer radiation to decrease cardiac radiation exposure. In previous trials, our group developed a preparatory regimen using high-flow nasal oxygen and hyperventilation to achieve voluntary Long Deep inspiration Breath-Holds (L-DIBH) exceeding 3 minutes (1). However, there is a substantial variability in L-DIBH duration among subjects, not explained by physical factors. We investigated whether mental exercises could increase the duration of the breath-hold. Material/Methods: Thirty-six subjects (20 healthy volunteers and 16 breast cancer patients) each performed 12 prolonged breath-holds over 4 sessions. During half of the sessions the subject was instructed to focus on a mental exercise, the starting order of sessions was randomized. Preparation consisted of 3 minutes of hyperventilation whilst receiving heated humidified nasal oxygen (FiO2=0.6) at 40L/min preceding each L- DIBH. For the mental exercise a slide show with different shapes of various colours was projected and the subject was asked to recognize and count per L- DIBH a specific shape and colour. Linear Mixed Models were used to analyse the impact of this exercise on L- DIBH duration. Results: All 36 subjects completed the 12 DIBHs for a total of 432 L-DIBHs, 216 with mental exercises. Mean L-DIBH duration was 152 seconds (SD 64s) in the total group and 126 seconds (SD 50s) in the patient subgroup. Figure 1 illustrates L-DIBH duration of the patient subgroup.
Regarding CAC_uncorr, Patient Age and FEC (neo- adjuvant anthracycline-based chemotherapy) were the best predictors at multi-variate analysis (AUC=0.73, p=0.0125). The addition of respiratory toxicity in the analysis significantly improved performances (AUC=0.77, p=0.0003). MHD did not result as a predictor for both endpoints.
Conclusion: CAC_corr events are influenced by CAC scores and age without any impact of laterality. Radiotherapy increases CAC_uncorr events, as 13/14 of these events occurred in left breast cancer patients. MHD was not a predictor of CAC_uncorr that depended mostly on age and anthracyclines; results also suggest an interplay with moderate/severe respiratory problems occurring in the first 3 years after Radiotherapy likely mediated by a mechanism similar to that observed after respiratory infections.The study was supported by the project TETRIS, HORIZON- EURATOM-2023-NRT-01
Grant Agreement number: 101166699. Keywords: Breast, Cardiac, Calcifications
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