Novel Use of Biphasic Cuirass Ventilation During Definitive Radiotherapy: A Technical Report.

Unstructured Abstract The use of biphasic cuirass ventilator supported radiotherapy has never been documented. We present the first technical report here. A 57-year-old man with obstructive sleep apnea presented with a T0N1M0 right sided, human papillomavirus related head and neck cancer diagnosed with excisional lymph node biopsy. On further work-up, the cancer was found to originate in the right tonsil and was staged as T1N1. The patient started definitive treatment with concurrent chemo-radiotherapy, but after 5 treatments, was no longer able to lay in a supine position for treatment. Diagnostic imaging work-up eventually revealed an idiopathic right sided hemi-diaphragm eventration. After consultation with cardiology, pulmonology and head and neck surgery, recommendation was made for tracheostomy in order to tolerate supine radiotherapy position, but the patient refused. Instead, CT simulation for radiotherapy re-planning was performed using a combination of biphasic cuirass ventilation, home continuous positive airway pressure and oxygen. The patient then tolerated definitive treatment to a dose of 69.96 Gray in 33 fractions with concurrent chemotherapy, with no unexpected side effects. Although complex, daily treatment set-up was consistent. Daily onboard imaging was precise and accurate. The patient continues to follow-up with radiation oncology, medical oncology and pulmonology. This is the first use of biphasic cuirass ventilator supported radiotherapy reported in the scientific literature. Although daily treatment set-up is complex, its use could be considered in patients unable to tolerate radiotherapy treatment positioning as an alternative to tracheostomy.