Investigation of the clinical benefits of regular breath-holding training utilizing surface guided radiation therapy technology for patients with left breast cancer

The deep inspiration breath-hold (DIBH) technique has indeed been widely applied in breast cancer radiotherapy, with numerous studies demonstrating its significant advantages in reducing radiation doses to the heart and lungs. However, previous research has primarily focused on the dosimetric benefits of the DIBH technique, with relatively little attention given to the stability and duration of breath-holding. This study aims to evaluate the practical benefits of regular breath-holding training in the DIBH workflow by quantitatively analyzing how such training reduces setup and treatment times and improves workflow efficiency. This single-center randomized, self-controlled clinical trial involved fifty patients diagnosed with left breast cancer. Twenty-five patients received regular breath-holding training throughout their treatment (trained group), while twenty-five control patients were provided only with basic instructions during their initial treatment session (untrained group). Data on breath-holding duration, radiotherapy setup time for the trained group, and overall treatment time for both groups were collected. Breath-holding stability was assessed by comparing Real Time Coach (RTC) from AlignRT at the setup stage, X-Ray Volume Imaging (XVI), and during treatment. In the training group, 22 patients (88%) completed regular breathing training, resulting in the collection of 363 sets of breathing training data. Regular training resulted in a gradual increase in breath-holding duration; specifically, setup time decreased from over 320 s during the first session to approximately 200 s by the fifth session. The trained group exhibited a significantly shorter treatment duration (233.85 ± 51.36 s) compared to the untrained group (323.71 ± 104.75 s; p < 0.05). RTC results at the setup stage, XVI, and during treatment showed no significant differences between groups (p > 0.05). Regular breath-holding training enhances both breath-holding duration and patient cooperation while strengthening doctor-patient relationships and reducing both setup and treatment times. It is recommended to incorporate regular breathing training into the workflow of peer DIBH treatment and to implement three breath-holding sessions during the setup process for fine-tuning and validation, aiming to optimize breath-holding stability.