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Radiotherapy Delivery in Deep Inspiration for Pediatric Patients-Final Results of the Phase II Feasibility Study
Daniella Elisabet Østergaard1,2, Anni Young Lundgaard1, Laura Ann Rechner1
1Department of Oncology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.
Insights
The TEDDI trial found deep-inspiration breath-hold (DIBH) feasible and safe for pediatric radiotherapy, reducing organ doses. Patients reported positive experiences, supporting DIBH for minimizing long-term risks.
Area of Science:
- Pediatric Oncology
- Radiation Therapy
- Medical Physics
Background:
- The TEDDI trial assessed the feasibility and reproducibility of deep-inspiration breath-hold (DIBH) in pediatric patients undergoing radiotherapy.
- This study presents final results, including patient-reported outcomes and dosimetric comparisons between DIBH and free-breathing (FB).
Purpose of the Study:
- To evaluate the feasibility and safety of DIBH in pediatric radiotherapy.
- To compare dosimetric outcomes between DIBH and FB techniques.
- To assess patient-reported outcomes associated with DIBH.
Main Methods:
- Pediatric patients eligible for thoracic or upper abdominal radiotherapy were recruited.
- DIBH training involved external gating and visual coaching during CT scans.
- Radiotherapy plans were generated for both DIBH and FB, with DIBH chosen for lower organ-at-risk doses.
Main Results:
- Twenty-five pediatric patients were enrolled; five received DIBH photon radiotherapy.
- Eleven patients rated DIBH training positively, reporting feeling safe and comfortable.
- DIBH demonstrated significant reductions in heart and lung radiation doses compared to FB.
Conclusions:
- The TEDDI trial confirms the feasibility and safety of DIBH in pediatric radiotherapy.
- High patient compliance and favorable dosimetric results support DIBH use.
- DIBH can reduce long-term toxicity risks in pediatric patients receiving radiotherapy.
Introduction:
The TEDDI trial tested the feasibility and reproducibility of deep-inspiration breath-hold (DIBH) in pediatric patients referred for radiotherapy. This report presents final results, including patient-reported outcomes (PRO) and dosimetric comparison of DIBH and free-breathing (FB).
Patients And Methods:
Pediatric patients able to perform three sequential breath-holds and potentially requiring thoracic or upper abdominal radiotherapy were recruited. DIBH training was during staging or planning computed tomography (CT) scanning, using external gating with an external marker and visual coaching. Each patient underwent planning CT in both DIBH and FB, generating two radiotherapy plans. DIBH was selected if it resulted in a lower overall dose to organs at risk. At two centers, patients evaluated their DIBH experience during training. Those treated in DIBH also completed three daily questions and extended questionnaires at the start, midpoint, and end of treatment, using yes/no and five-point Likert scales.
Results:
Twenty-five patients (12 females/13 males, median age 15 years, range: 9-17 years) were enrolled across three centers. Eight received photon radiotherapy, five in DIBH. Of 13 eligible patients, 11 rated DIBH training, with 10 selecting "Really good" or "Good." Patients treated in DIBH reported feeling safe and comfortable. Dosimetric analysis showed clear heart and lung dose reductions with DIBH. FB patients had similar doses across both plans.
Conclusion:
The TEDDI trial demonstrated the feasibility and safety of DIBH in pediatric radiotherapy. High compliance with the procedure and favorable dosimetric outcomes support the use of DIBH to reduce long-term toxicity risks in this population.
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