Technical Innovations & Patient Support in Radiation Oncology · Published 2026-06-13 · DOI 10.1016/j.tipsro.2026.100418
N. Audag, D. Di Perri, A. Razavi, S. Da Rita Quaresma, M. Gabriels, M. Alvear-Garcia, E. Alvarez-Moreno, B. Brichard, G. Van Ooteghem
Background and purpose: Respiratory motion is a major challenge in paediatric thoracic radiotherapy, where minimizing exposure to healthy tissues is essential to reduce long-term toxicity. Mechanically-assisted non-invasive ventilation deep inspiration breath-hold (MANIV-DIBH) allows non-sedated patients to achieve repeated, reproducible breath-holds, potentially reducing safety margins and improving dose conformity. We report the first paediatric application of this technique during whole lung irradiation (WLI). Material and methods: A 10-year-old girl with metastatic Ewing sarcoma was referred for WLI. A preparatory session with a physiotherapist was performed to introduce MANIV-DIBH with child-adapted communication and select the optimal non-vented oronasal mask. Ventilator settings for assisted breath-holds were tailored to the patient's tolerance. The goal was to achieve multiple 20-s breath-holds. The simulation CT was acquired during MANIV-DIBH. WLI (15 Gy in 10 fractions) was planned with IMRT. Results: The patient performed stable and reproducible 20-s breath-holds across 10 sessions, with an average fraction time of 32.1 (±7.8) minutes. Treatment was well tolerated, with grade 2 fatigue. Follow-up PET/CT showed complete response and no imaging signs of toxicity. Conclusion: This first paediatric clinical application of MANIV-DIBH suggests feasibility, stability, and good tolerability. Its successful use required careful, multidisciplinary implementation and adaptation to the paediatric setting. These preliminary findings support further evaluation in this population.
Abstract from DOAJ. Public domain (CC0 1.0).
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Audag, N., Perri, D., Razavi, A., et al. (2026). Mechanically-assisted non-invasive deep inspiration breath-hold (MANIV-DIBH): A first clinical application in paediatric radiotherapy. Technical Innovations & Patient Support in Radiation Oncology. https://doi.org/10.1016/j.tipsro.2026.100418