Safely achieving single prolonged breath-holds of > 5 minutes for radiotherapy in the prone, front crawl position

Objective: Breast cancer radiotherapy is increasingly delivered supine with multiple, short breath-holds. There may be heart and lung sparing advantages for locoregional breast cancer of both prone treatment and in a single breath-hold. We test here whether single prolonged breath-holds are possible in the prone, front crawl position. Methods: 19 healthy volunteers were trained to deliver supine, single prolonged breath-holds with preoxygenation and hypocapnia. We tested whether all could achieve the same durations in the prone, front crawl position. Results: 19 healthy volunteers achieved supine, single prolonged breath-holds for mean of 6.2 ± 0.3min. All were able to hold safely for the same duration while prone (6.1 ± 0.2min ns. by paired ANOVA). With prone, the increased weight on the chest did not impede chest inflation, nor the ability to hold air in the chest. Thus, the rate of chest deflation (mean anteroposterior deflation movement of three craniocaudally arranged surface markers on the spinal cord) was the same (1.2 ± 0.2, 2.0 ± 0.4and 1.2 ± 0.4mm/min) as found previously during supine prolonged breath-holds. No leakage of carbon dioxide or air was detectable into the facemask. Conclusion: Single prolonged (>5min) breath-holds are equally possible in the prone, front crawl position. Advances in knowledge: Prolonged breath-holds in the front crawl position are possible and have the same durations as in the supine position. Such training would therefore be feasible for some patients with breast cancer requiring loco-regional irradiation. It would have obvious advantages for hypofractionation.