Continuous Positive Airway Pressure Device or Deep Inspiration Breath Hold in Reducing Tumor Motion in Patients Undergoing Stereotactic Body Radiation Therapy for Lung Cancer

PRIMARY OBJECTIVES:

I. To compare the two methods of tumor motion management, continuous positive airway pressure (CPAP) and deep inspiration breath hold (DIBH) and to estimate the decrease in tumor motion from free breathing for CPAP and DIBH.

SECONDARY OBJECTIVES:

I. To determine if CPAP is a more time-efficient option for tumor motion management than is DIBH.

Ia. Determine if CPAP is better tolerated by patients than is DIBH. Ib. Determine the reproducibility of lung expansion and tumor motion reduction by CPAP.

Ic. Determine if the dosimetric coverage of the tumor and the sparing of the normal tissues with CPAP is comparable to that with DIBH.

Id. Measure treatment time differences between CPAP and breath hold (DIBH) treatments.

OUTLINE:

Patients undergo free-breathing, DIBH, and CPAP CT simulation scans. If patient has difficulty exhaling on CPAP, then patient undergo biphasic positive airway pressure (BiPAP) CT simulation. The attending physician then compares all 3 simulation treatment plans (free-breathing, DIBH, and CPAP/BiPAP) and determines which method to use during SBRT. If CPAP/BiPAP is chosen as preferred method, patients wear CPAP/BiPAP over 1 hour prior to SBRT, then again during SBRT over 30-60 minutes. All other patients complete free-breathing or DIBH during SBRT over 30-60 minutes.

• Biphasic Positive Airway Pressure (Device), also known as BiPAP, Biphasic positive airway pressure (BiPAP): Receive BiPAP
• Computed Tomography (Procedure), also known as CAT, CAT Scan, Computerized Axial Tomography, computerized tomography, CT, CT SCAN, tomography: Undergo CT simulation scans
• Continuous Positive Airway Pressure (Procedure), also known as Continuous positive airway pressure (CPAP), CPAP: Receive CPAP
• Deep Inspiration Breath Hold (Procedure), also known as DIBH: Complete DIBH
• Radiation Therapy Treatment Planning and Simulation (Radiation), also known as Radiation Therapy Treatment Planning/Simulation: Undergo CT simulation scans
• Stereotactic Body Radiation Therapy (Radiation), also known as SABR, SBRT, Stereotactic Ablative Body Radiation Therapy: Undergo SBRT

Primary outcomes

• Estimation of decrease in tumor motion [Up to 10 days]: Paired t-test will be used to compare continuous positive airway pressure (CPAP) to deep inspiration breath hold (DIBH) in the decrease of tumor motion from free breathing. Linear regression may be used to evaluate the difference between CPAP and DIBH in the decrease of tumor motion from free breathing with the adjustment of important demographic and clinical variables in the model.

Secondary outcomes

• Increase in lung volume [Up to 10 days]: Increase in lung volume to be determined by using DIBH or CPAP from free breathing. Linear regression may be used to evaluate the difference between CPAP and DIBH in the increase of lung volume from free breathing with the adjustment of important demographic and clinical variables in the model. The study will summarize the data with mean, standard deviation, median and range for continuous variables, and frequency count and percentage for categorical variables
• Assessment of time to deliver the planned radiation dose by using the most appropriate method [Up to 10 days]: The study will summarize the data with mean, standard deviation, median and range for continuous variables, and frequency count and percentage for categorical variables.

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* The patient will receive stereotactic body radiotherapy in the Thoracic Radiation Oncolcogy Service at MD Anderson.

Exclusion Criteria:

* The patient has a contra-indication for using a CPAP device.
* The patient has not signed a study-specific informed consent for this study.
* The patient is uncooperative.
* The patient has reduced consciousness.
* The patient has sustained trauma or burns to the face.
* The patient has undergone any facial, esophageal, gastric or sinus surgery within the last 3 months.
* The patient has idiopathic pulmonary fibrosis (IPF) as documented in their medical history.
* Adults who are unable to consent, individuals who are not yet adults, pregnant women and prisoners will be excluded from this study.

• Julianne M Pollard, Principal investigator, M.D. Anderson Cancer Center