What question did this study set out to answer?

This study aims to assess the feasibility and tolerability of continuous positive airway pressure during stereotactic ablative radiotherapy for central lung tumors.

April 4, 2026

Stereotactic Ablative Radiotherapy for Central Lung Tumors: A Preliminary Study Assessing the Feasibility of Continuous Positive Airway Pressure

Key Points

This study aims to assess the feasibility and tolerability of continuous positive airway pressure during stereotactic ablative radiotherapy for central lung tumors.
Prospective recruitment of patients with central lung tumors for SABR treatment at 60 Gy in eight fractions.
Patients fitted with CPAP masks and assessed for tolerability at pressures up to 15 cmH2O.
4D-CT planning imaging conducted with both standard free breathing and CPAP techniques.
Forward-planned 3D conformal SABR plans generated for each technique.
Twelve of 14 patients tolerated CPAP and underwent CT simulation with both techniques.
CPAP plans were preferred in 8 out of 12 patients.
Mean PTV–OAR displacement was 5.8 mm with CPAP compared to 4.1 mm with free breathing.
Mean maximum dose to the primary central organ at risk was lower in the CPAP group (46.4 Gy) than the standard group (51.3 Gy).

Abstract

ABSTRACT Introduction Continuous positive airway pressure (CPAP) has been demonstrated to provide favorable physiological changes for lung stereotactic ablative radiotherapy (SABR) delivery. This study investigates its specific utility for central lung tumors. Methods Patients with central lung primary or metastatic tumors were recruited prospectively for SABR treatment with 60 Gy in eight fractions. All patients were fitted with CPAP masks and assessed for tolerance of pressures up to 15 cmH 2 O. 4D‐CT planning imaging was acquired in standard free breathing and CPAP techniques. Forward‐planned 3D conformal SABR plans were generated for both techniques for each patient. Outcomes for analysis included plan selection, planning target volume (PTV) displacement distance from primary central organ at risk (OAR), target volume size, target volume and OAR dosimetry, and qualitative analysis of CPAP tolerability. Results Twelve of 14 patients tolerated CPAP and underwent CT simulation and planning with standard and CPAP techniques. CPAP plans were preferred in 8 of the 12 patients. The mean PTV–OAR displacement was 5.8 mm (SD = 9.29) with CPAP compared to 4.1 mm (SD = 6.13) with free breathing ( p = 0.65). The mean maximum dose to the primary central OAR was 46.4 Gy (SD = 16.9) in the CPAP group and 51.3 Gy (SD = 15.8) in the standard group ( p = 0.22). Conclusion CPAP is a safe and well‐tolerated treatment adjunct in central lung SABR. Further investigation is required to determine whether CPAP can provide dosimetric advantages.

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