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187 BREATH HOLD IN COMPARISON TO OTHER MOTION...
Journal article

187 BREATH HOLD IN COMPARISON TO OTHER MOTION MANAGEMENT STRATEGIES FOR LIVER SBRT: A SCOPING REVIEW

Abstract

Purpose: Organ motion management is paramount in liver stereotactic body radiotherapy (SBRT) to improve treatment accuracy. Various techniques have been developed including breath hold (BH), abdominal compression (AC), 4DCT, and gating. It is unclear if BH provides oncologic benefits when compared to other motion management strategies. The objective of this scoping review is to evaluate the current literature comparing BH to other motion management strategies for liver SBRT. Materials and Methods: A scoping review was performed using the PRISMA-ScR checklist. MEDLINE and EMBASE databases were searched for English-language studies that evaluated liver SBRT published before June 2024. At least 50% of the target lesions needed to be hepatic (primary or secondary malignancies were included). Studies were mandated to compare BH to other motion management strategies. Two evaluators independently reviewed the studies for eligibility. Results: Our search strategy yielded 1127 references, of which, 32 studies were included in our final review. Various liver SBRT scenarios were captured, including hepatocellular carcinoma (HCC) alone (8/32), liver metastases (8/32), both HCC and metastases (9/32), or unspecified (7/32). BH was compared to free breathing (21/32), gating (4/32), AC (4/32), or others (3/32). The majority of studies (25/32, 78.1%) assessed changes in the target volume, including GTV, ITV or PTV sizes. Dosimetric analysis of targets and/or organs at risk (OAR) was conducted in 16 studies. Clinical outcomes were reported in 7 studies. Logistics of BH, such as treatment time, were described in 8 studies. Only 1 study reported patient satisfaction outcomes. BH generally decreased target volume sizes and OAR doses when compared with free-breathing. However, comparing BH to any motion management strategies showed mixed results on local control or progression-free survival. Conclusions: Despite the potential benefits of BH in reducing target volumes and OAR doses, its impact on oncologic outcomes remains uncertain due to study heterogeneity. Future prospective studies should directly assess the impact of BH on both oncologic and patient-reported outcomes to determine whether its dosimetric benefits can translate into meaningful clinical advantages.

Authors

Kong I; Yakub Z; Lee J; Swaminath A; Darvish-Molla S; Shim M; Wong R

Journal

Radiotherapy and Oncology, Vol. 210, , pp. s77–s78

Publisher

Elsevier

Publication Date

September 1, 2025

DOI

10.1016/s0167-8140(25)04850-9

ISSN

0167-8140

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