New breathing technique at Mays Cancer Center protects healthy tissue from radiation treatment
Mays Cancer Center Annual Report
“We know that there is a dose response relationship with tumors, where higher doses yield better outcomes approaching surgery. Usually, the bowel limits the ability to go this high, but this technique can yield more room to dose escalate. I like to offer higher doses when possible, and that only happens comfortably with DIBH.”
– Neil Newman, MD, radiation oncologist at Mays Cancer Center
That simple act of holding a breath during a radiation cancer treatment called deep inspiration breath-hold (DIBH) could mean the difference between irradiating healthy tissue and sparing it, according to Neil Newman, MD, assistant professor in the Department of Radiation Oncology at The University of Texas Health Science Center at San Antonio.
“It has major advantages. When you breathe, your bowels move, and you are actually moving your bowels closer to your tumor and radiation field, which could risk more side effects,” Newman said.
How DIBH works
The breath hold moves the heart away from the tumor and the radiation treatment. Cameras in the radiation treatment room at Mays Cancer Center monitor patients as they inhale and exhale. During each inhalation and hold, a machine beams radiation into the planned area of the body. When the patient exhales, the machine stops the treatment.
Holding your breath for 25–30 seconds is not easy for most. Patients in good physical condition are eligible to try the technique and have time to practice ahead of the treatment.
Practice sessions begin at the Mays Cancer Center in a room aglow with green or red lights. Newman said when patients hold their breath, the room is lit green, indicating they are doing a good job. When they exhale, the room turns red. He said the practice sessions allow him to capture images of the position of tumors during the inhale. Then, he creates an individualized treatment plan.
“When the patient comes in for treatment, we take verification scans to ensure everything is in the same position as the practice sessions, and then we treat the patient,” Newman said.
One DIBH patient’s story
Cruz Jimenez III, a 59-year-old physical therapist, was diagnosed with bile duct cancer in February 2023.
Bile duct cancer is rare—only about 8,000 people are diagnosed each year. Jimenez’s cancer began in his bile ducts but quickly became a complicated case.
Survival rates for the disease, according to the American Cancer Society, range from 23% to 11%, depending on whether the cancer is located inside or outside the liver. Jimenez’s cancer was both inside and outside the liver.
After his initial diagnosis, he was given nine to 12 months to live, so he and his wife planned a bucket list of trips across the country.
After undergoing chemotherapy at another location, where the treatment damaged his bone marrow, a doctor told Jimenez that there were very few options for treatment. Seeking a second opinion, Jimenez contacted the Mays Cancer Center. He spoke with Colin Court, MD, PhD, surgical oncologist and assistant professor in the Division of Surgical Oncology and Endocrine Surgery at The University of Texas Health Science Center at San Antonio, who gave him better news.
“Dr. Court said he spoke to his biliary team, and they said, ‘We feel like we can get it,’” Jimenez said.
DIBH in action
The location of the tumor made it difficult to remove it surgically, so Jimenez began radiation therapy with Dr. Newman. He was an eligible candidate for DIBH, so Newman aggressively treated the cancerous tumor.
Jimenez was no stranger to DIBH, having used the technique during a CT scan earlier in his life. He was so good at holding his breath that he cut the time of his radiation treatments.
When Jimenez met Newman, his blood test biomarkers (CA19-9) were at 196, much higher than the normal range of less than 37. Biomarkers are characteristics in the blood that may be within a normal range or indicate disease.
After 15 treatments with DIBH, allowing higher doses of radiation, his CA19-9 dropped to 11 with tumor shrinkage on CT scans.
“The radiation treatment totally inactivated the tumor,” Newman said.
A new lease on life
By January, the radiation treatment had shrunk the inactive tumor small enough for surgical removal. Now, well past the short life expectancy he was first given, Jimenez is recovering, though it’s slow and painful. He said the average recovery time for the surgery to remove the tumor is four to six months.
Jimenez said he is easily fatigued and suffering multiple effects of the surgery; however, he tries to stay active, rehabbing his son’s duplex.
“Working on the duplex gets me through the day. I feel so guilty and beat when I have to sit on the couch. But the pain reminds me I’m still here,” he said.
