Patients will be treated during spontaneous breath hold wich is considered as the gold-standard radiotherapy treatment for left breast cancer.

Irradiation will take place during DIBH induced by MANIV (Bellavista 1000, IMTMedical®) with SL mode. Oxygen will be added (FiO2 60%) to safely and easily prolong the DIBH duration up to 40-50 seconds to allow the complete delivery of a treatment beam.

Irradiation will take place during DIBH induced by the MANIV (Bellavista 1000, IMTMedical®) with SL mode. Oxygen will be added (FiO2 60%) to safely and easily prolong the DIBH duration up to 40-50 seconds to allow the complete delivery of a treatment beam [13]. Prior to treatment, a radio-opaque fiducial will be implanted in the tumor by an interventional radiologist, to facilitate the tumor position monitoring from onboard imaging. Residual tumor baseline shift and motion will thus be measured during beam delivery, and used to recompute the optimal safety margins that ensure an adequate dose coverage of at least 90% of tumors, according to literature recommendations [24]. We will also compare these safety margins computed under MANIV condition with those routinely applied in free-breathing condition (from a matched retrospective cohort) to estimate the gain in terms of margin reduction.

Patients will be ventilated by VC mode during their treatment. For each fraction, the treatment time, the number of reconstructions of the tracking model and the correlation errors of the model will be collected. The same information will be extracted from a matched retrospective cohort treated by tracking in spontaneous breathing.

Data on tumor position and its residual motion from patients included in the arm n°3 will be used to compute the planned and in silico delivered dose distribution with PBS PT. The MIRO lab (UCLouvain - IREC) has developed comprehensive tools for simulating treatment delivery on patients CT images using the Monte Carlo dose engine MCsquare [25], coupled with log-file acquisitions [26]. In this way, we will be able to validate our approach in silico in collaboration with IBA, as a first step before conducting prospective trials for the clinical validation of this approach.

Optimization of Motion Mitigation Strategies by Mechanically-Assisted Non-Invasive Ventilation

mechanical ventilator (Bellavista 1000, IMTmedical) will be used on Varian® Halcyon LINAC and Infinity Elekta® linac

MANIV

performed on Varian® Halcyon LINAC and Infinity Elekta® linac

Spontaneous DIBH

Mechanically-Assisted and Non-Invasive Ventilation for Breathing-related Tumor Motion Mitigation.

Implementation and Clinical Validation of Mechanically-Assisted and Non-Invasive Ventilation (MANIV) in Radiotherapy for Breathing-related Tumor Motion Management.

mean breast gland 3D displacements during treatment delivery.

Proportion of tumors receiving the prescribed dose within each cohort

Average time required to deliver a fraction

% of CTV volume receiving at least a given dose level by patient

Cliniques universitaires Saint-Luc- Université Catholique de Louvain

Multicentric prospective interventional or retrospective observational study depending on the sub-part considered. It is segmented into 5 sub-parts each investigating the interest of MANIV for a specific motion management technique.

prumnopitys andina/syöpä

Mechanically-Assisted and Non-Invasive Ventilation for Breathing-related Tumor Motion Mitigation.

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