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Stereotactic Body Radiation Therapy Treatment by Deep Inspiratory Breath Hold in a Patient with Permanent Tracheostomy: Technical Solution and Clinical Implementation – A Case Report
Sasmita Priyadarshini Sahu, Panomali Dayakar Reddy, Susovan Banerjee, Deepak Gupta, Shyam Singh Bisht, Amarendra Amar and Tejinder Kataria

Patients with limited stage lung cancer or with oligometastatic lung lesions, Stereotactic body radiotherapy (SBRT) offers a chance of radical cure by delivering ablative dose to the tumor with achieving constraint for critical organs at the same time
(1) (2) (3). For lung SBRT we may do a real time tumor tracking planning by CyberKnife, 4DCT based gating planning or a deep inspiratory breath hold (DIBH) planning depending on available resources and location of the tumor. Evidences suggest using DIBH technique during SBRT for lung lesion can achieve prescribed dose to the target with acceptable organ at risk constraints including low mean lung dose. (4) (5).

While DIBH is an excellent method to target lung tumor by SBRT it can only be used when patient has a normal physiological airway conducting system and moderate to good pulmonary function. If the patient has a compromised airway like tracheostomy, he or she is generally not a suitable candidate for SBRT by DIBH treatment. We encountered a similar problem and successfully treated the patient with permanent tracheostoma by making an air conducting circuit compatible with DIBH machine from available resources used in our routine anesthesia practice. We hereby present the case for dissemination of the technique for benefit of other patients.

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