Safety and feasibility of High-Frequency Oscillatory Ventilation for the control respiratory movement in patients with Thoracoabdominal Tumors receiving Heavy Ion precision Therapy

Safety and feasibility of High-Frequency Oscillatory Ventilation for the control respiratory movement in patients with Thoracoabdominal Tumors receiving Heavy Ion precision Therapy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Safety and feasibility of High-Frequency Oscillatory Ventilation for the control respiratory movement in patients with Thoracoabdominal Tumors receiving Heavy Ion precision Therapy Yi Wang, Wenxue Zhao, Yutian Tang, Fang Wang, Yancheng Ye, Yanshan Zhang, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4315900/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction; The aim of this study was to investigate the safety and feasibility of the high-frequency oscillatory ventilation (HFOV) technique for the management of respiratory motion in patients with thoracoabdominal malignancies undergoing heavy ion precision therapy. Methods; A retrospective analysis of clinical data from 30 patients with thoracoabdominal malignant tumors treated with heavy ion therapy under the control of high-frequency oscillatory ventilation at one Cancer Hospital was conducted from January 2023 to March 2024. Patient's general conditions, respiratory motion, and other clinical parameters were analyzed and compared before, during, and after the treatment to determine the value of utilizing HFOV for managing thoracoabdominal malignancies in patients undergoing heavy ion therapy. Results; There was no significant difference in heart rate, blood pressure, blood oxygen saturation, or tcpCO2 before, during, or after treatment ( P > 0.05). In addition, HFOV improved the patient's tcpO2 values ( P < 0.001). However, the lung respiratory motion under HFOV was 1.33 ± 0.39 mm, which was significantly lower than that in the spontaneous respiration status (19.31 ± 4.22mm, P < 0.001), and "missed targeting" was not observed during radiotherapy. Throughout the treatment process, one case complicated with hypertension and hypercapnia was observed, and two patients experienced nausea and vomiting after extubation. Radiation pneumonia occurred in 1 of 30 patients, and the mean hospital stay was 22.13 ± 10.94 days. The results showed that the objective response rate was 93.1%, the complete response rate was 41.37%, and the partial response rate was 51.72%. No death occurred during the follow-up period. Conclusion; HFOV is safety for thoracoabdominal tumor patients to receive high doses of precise heavy ion therapy, thereby enhancing treatment efficacy. Further randomized controlled trial is needed to confirm this discovery. High-frequency oscillation ventilation Breathing control Heavy ions Precision radiotherapy Thoracic and abdominal tumors Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction The incidence of tumors is increasing annually, seriously affecting human health. Surgery and radiotherapy are important treatment modalities for malignant tumors, with approximately 70% of cancer treatment regimens involving radiation therapy. The principle behind radiation therapy is to reduce the size of the tumor area by disrupting cell division through radiation. However, during radiotherapy, it is also possible to affect healthy cells [ 1 , 2 ]. Heavy ion therapy is currently the most advanced technology for tumor radiation therapy. Heavy ion beams are high-LET radiation that benefit physical dose distribution (Bragg peak). There is a minimal risk of exposure to organs located beyond the range endpoint, high biological efficacy in the peak region, and significant therapeutic effects have been achieved in the clinical treatment of tumors thus far [ 3 ]. However, the location of thoracoabdominal tumors changes with respiratory motion during treatment, posing a challenge as respiratory motion can cause deviations in the position of the radiation therapy target relative to the accelerator's static irradiation field [ 1 , 2 ]. Respiratory motion is one of the important factors affecting the efficacy of "precision radiation therapy" for thoracic tumors. The relative position between the scatter beam and the target area changes as a result of motion during irradiation, leading to inconsistencies between the actual dose received by the patient and the planned dose [ 4 , 5 ]. This seriously affects the precision of heavy ion radiation therapy for tumor sites and results in unnecessary damage to healthy tissues. Therefore, there is an urgent clinical need for a safe and effective means of controlling respiratory motion during heavy ion therapy. High-frequency oscillatory ventilation (HFOV) characterized with a high frequency, small tidal volume, and adequate mean airway pressure may limit patient's respiratory movements during ventilation [ 6 , 7 ]. Theoretically, it is an ideal approach to control the respiratory movement during therapy and make the precise heavy ion therapy possible. Under the basis of preliminary tests involving healthcare professionals and volunteers in our center demonstrating the safety of HFOV, we pioneered the application of HFOV in the treatment of thoracoabdominal tumors subjected to heavy ion therapy.. Currently, this technology has been successfully applied in the treatment of 30 cases. We retrospectively analyzed the clinical data of these 30 patients and discussed the value of HFOV technology in heavy ion therapy, providing insights and references for precision radiation therapy. Materials and Methods General Information This study was approved by the ethic committee of clinical research from Wuwei Cancer Hospital. Clinical data were retrospectively analyzed for patients with thoracoabdominal tumors who underwent HFOV-controlled heavy ion therapy at Gansu Province Wuwei Cancer Hospital from January 2023 to March 2024. All patients had been previously diagnosed with malignant tumors at other hospitals and had undergone systemic antitumor treatment. The enrolled patients were generally in good condition, without contraindications to radiation therapy, and without current history of severe pulmonary and cardiac dysfunction, severe hypertension, cardiac arrhythmias, refractory hypotension, passive dependence on pulmonary blood flow, acute exacerbation of respiratory and circulatory diseases, or allergies to analgesics or sedatives. Instruments and Monitoring HFOV was provided by the ventilator (CareFusion 3100B HFOV, California, USA).TCM Combi M transcutaneous oxygen/carbon dioxide tension monitoring device and bedside electrocardiogram monitor were used to monitor the vital signs. Bispectral index (BIS) monitor was applied to monitor the sedation level, and Train-of-four (TOF) neuromuscular stimulator was used for monitoring levels of paralysis. Treatment Procedure HFOV was used to control the respiration in patients under deep sedation (with etomidate and sufentanil) and adequate muscle relaxation (with rocuronium bromide). Following cessation of spontaneous breathing, tracheal intubation was performed, and 4-D CT positioning was conducted under HFOV control. The initial settings for the HFOV were as follows: frequency 480–600 cycles per minute (8–10 Hz), mean airway pressure (Paw) 10 cmH2O, amplitude 6 cm, tidal volume (Vt) 62.5 ml (determined by amplitude and frequency), inspiratory time 30%, fraction of inspired oxygen (FiO2) 40%, and bias flow 30 L/min. This ensured adequate airway pressure, oxygen saturation, tidal volume, oxygen partial pressure, and carbon dioxide partial pressure. After positioning, patients were transferred to the intensive care unit (ICU) for assisted ventilation with a conventional ventilator while awaiting target area delineation. After target area delineation, patients were transported to the heavy ion therapy room for heavy ion therapy under HFOV control. Following completion of heavy ion therapy, patients were transferred back to the ICU, awakened, extubated upon restoration of spontaneous breathing, and then sent to a general ward. Throughout the procedure, PO2 and PCO2 levels were continuously monitored, and the BIS 、modified observer’s assessment of alert (MOAA/S) 、Ramsay score and Richmond Agitation and sedation scale(RASS), and TOF were maintained suitable levels to ensure patient comfort and safety. Evaluation Criteria The patients' heart rate (P), blood pressure (mean arterial pressure, MAP), oxygen saturation (SO2), transcutaneous oxygen tension (tcpO2), transcutaneous carbon dioxide tension (tcpCO2), diaphragm movement, subjective feelings during the 2-48-hour post-treatment period, and general condition were monitored. Late-phase side effects and efficacy were also assessed. According to the solid Tumor Efficacy Evaluation Criteria (RECIST)[ 8 ], the patients' efficacy was evaluated. Complete response (CR) was defined as the disappearance of all target lesions.Partial response (PR) was defined as a reduction of at least 30% in the sum of the longest diameters of the target lesions compared to baseline status.Stable lesion (SD) is defined as somewhere between partial remission and disease progression.Objective response rate(ORR) was generally defined as the sum of complete response plus partial response Statistical Analysis; All statistical analyses were performed using SPSS version 26.0. Normally distributed data are presented as the mean ± standard deviation, and non-normally distributed data are presented as the median (range). Student's t test was used for normally distributed data, and the Mann‒Whitney U test was used for non-normally distributed data. ANOVA was use to compare the repeated measures. A significance level of P < 0.05 was considered statistically significant. Results General Clinical Data; A total of 30 patients was included. Among them, 19 were male and 11were female with a median age of 54.5 years (range: 35–81 years). 12 had secondary lung malignancies, 7 had primary lung malignancies, 6 had pancreatic malignancies,3 had liver malignancies, 1 had secondary liver malignancies, 1 had intrahepatic bile duct malignancy, and 1 had breast malignancy. Eighteen radiation sites were located in the lungs, 6 in the pancreas, 4 in livers, 1 in the intrahepatic bile duct, and 1 in the breast, as detailed in Table 1 . Primary and liver tumors often presented with multiple lesions, with one patient having 11 metastatic lesions in the left lung. Treatment was completed in a single session for patients with multiple lesions, as illustrated in Fig. 1 . Table 1 Characteristics of patients No. Diagnosis Site of the radiation No. Diagnosis Site of the radiation 1 Malignant tumor of the liver Secondary malignant tumor of the lung Left Lung 16 Malignant tumor of the colon Secondary malignant tumor of the lung Left Lung 2 Malignant tumor of the colon Secondary malignant tumor of the lung Left Lung 17 Malignant tumor of the lung Left Lung 3 Malignant tumor of the liver Secondary malignant tumor of the lung Right Lung 18 Cervical malignancy Secondary malignant tumor of the lung Right Lung 4 Malignant tumor of the lung Left Lung 19 Pancreatic malignancy Pancreas 5 Rectocolonic malignancy Secondary malignant tumor of the lung Left Lung 20 Malignant tumor of the liver Secondary malignant tumor of the lung Left Lung 6 Pancreatic malignancy pancreas 21 Malignant tumor of the liver Liver 7 Pancreatic malignancy pancreas 22 Malignant tumor of the liver Liver 8 Pancreatic malignancy pancreas 23 Pancreatic malignancy pancreas 9 Intrahepatic bile duct malignancy Intrahepatic bile duct 24 Malignant tumor of colon Secondary malignant tumor of Liver 10 Pancreatic malignancy pancreas 25 Malignant tumor of the lung Right Lung 11 Gastric malignancy Secondary malignant tumor of the lung Left Lung 26 Malignant tumor of the liver Liver 12 Breast malignancy Right mammary gland 27 Malignant tumor of the colon Secondary malignant tumor of the lung Right Lung 13 Lung malignancy tumor Right Lung 28 Malignant tumor of the lung Right Lung 14 Bile duct malignancy Secondary malignant tumor of the lung Right Lung 29 Malignant tumor of the lung Both lungs 15 Malignant tumor of the lung Right Lung 30 Bile duct malignancy Secondary malignant tumor of lun Left Lung Changes of vital signs during the Treatment Period; Analysis of monitoring parameters during the treatment period indicated that there was no statistically significant difference ( P > 0.05) in heart rate, blood pressure, or blood oxygen saturation before, during, or after treatment. Additionally, there was no statistically significant difference ( P > 0.05) in tcpCO2 values before, during or after treatment. In addition, tcpO2 values during treatment were significantly higher than those before and after treatment ( P < 0.001), as detailed in Table 2 . Table 2 Changes of vital signs during treatment Parameters Baseline After Intubation Location10 min Location 30 min Target volume delineation 10 mins after heavy ion therapy 30 mins After heavy ion therapy After extubation P value with repeat measure P(beats/min) 77.60 ± 10.03 73.07 ± 8.87 74.20 ± 8.27 74.27 ± 7.59 76.60 ± 8.01 75.97 ± 9.50 77.77 ± 8.88 76.30 ± 8.57 0.339 MAP(mmHg) 80.43 ± 8.51 79.970 ± 8.34 81.67 ± 8.50 78.40 ± 8.83 80.47 ± 7.53 81.53 ± 11.07 83.67 ± 7.87 81.00 ± 7.16 0.470 SO 2 (%) 96.27 ± 1.57 96.70 ± 1.37 97.13 ± 2.57 96.53 ± 2.45 96.57 ± 1.38 96.77 ± 1.52 96.63 ± 1.67 96.53 ± 1.66 0.7797 tcpO 2 (mmHg) 89.93 ± 6.03 97.57 ± 3.36 *# 97.00 ± 3.86 *# 96.83 ± 4.33 *# 96070 ± 4.43 *# 97.50 ± 5.41 *# 97.03 ± 3.61 *# 92.70 ± 5.03 0.000 tcpCO 2 (mmHg) 43.97 ± 4.28 45.73 ± 2.98 45.77 ± 3.15 46.83 ± 2.95 45.63 ± 3.24 45.90 ± 5.23 46.87 ± 7.18 44.20 ± 5.14 0.116 Compared with baseline, * P < 0.05; compared with extubation, # P < 0.05. Comparison of Respiratory Motion between spontaneous respiration and HFOV All 30 patients underwent 4-D CT scans in both spontaneous respiration and controlled respiratory (HFOV) status. Respiratory motion was measured with diaphragm movement in both status. In one typical patientm the diaphragm motion was 21.50mm under spontaneous breathing and 1.50mm under HFOV, as depicted in Fig. 2.It was observed that respiratory motion during HFOV was 1.33 ± 0.39mm, which was significantly lower than that during spontaneous breathing (P < 0.001), as depicted in Table 3and Fig. 3 . The "off-target" phenomenon is that the tumor moves out of the irradiation field and does not get enough radiation dose, 30 patients did not occur "off-target" phenomenon Table 3 Diaphragm movement during spontaneous breathing and HFOV Diaphragm movement during spontaneous breath (mm) Diaphragm movement during HFOV(mm) P值 19.31 ± 4.22 1.33 ± 0.39 0.000 Figure 2 4-DCT of a typical patients with spontaneous breathing (a and b, diaphragm movement 21.50 mm) and with HFOV (c and d, diaphragm movement 1.50 mm) Side Effects during and after Heavy Ion Therapy under HFOV During the treatment process, one patient experienced hypertension, which was successfully managed with medication to normalize blood pressure. Another patient developed hypercapnia; however, this was primarily influenced by oscillation amplitude and frequency. After adjusting the parameters of the ventilator (increasing amplitude and decreasing frequency to increase tidal volume), the carbon dioxide partial pressure gradually returned to normal. Two patients experienced nausea and vomiting after extubation, which was most likely due to insufficient fasting time before treatment or the effects of analgesics and sedatives. Symptomatic treatment was administered and led to improvement. Radiation pneumonia occurred in 1 of the 30 patients, and the mean hospital stay was 22.13 ± 10.94 days. For pancreatic malignancies and intrahepatic bile duct malignancies, conventional heavy ion treatment was followed by intensive heavy ion treatment under high-frequency oscillation breathing control, so the hospital stay was longer. Efficacy evaluation 1 patient did not reach the evaluation time during follow-up, and other 29 patients' efficacy was followed. Complete response (CR) was found in 12 cases (41.37%), partial response (PR) in 15 cases (51.72%), stable disease (SD) in 2 cases (6.90%), and objective response rate (ORR) was 93.10%, as shown in Table 4and Fig. 4 . Up to the follow-up date, no death occurred in 30 patients. Table 4 29 Evaluation of curative effect in 29 patients Efficacy CR PR SD PD ORR n(%) 12(41.37) 15(51.72) 2(6.90) 0(0.00) 27(93.10) Discussion This study demonstrated that HFOV controlled respiration during heavy iron radiation therapy was safety with stable hemodynamics and gas exchange. In addition, HFOV could significantly decreased the diaphragm movement, which was ideal for tumor location during radiation therapy. This is the first study to show the safety and efficacy of HFOV during heavy iron therapy. The heavy ion therapy has two major advantages compared to traditional photon therapy. One is the advantage of the Bragg peak physics, and the other is the relative radiation biological effect. The Bragg peak's occurrence in the depth of the biological body is highly sensitive to the entry of carbon ions, meaning that once a certain amount of carbon ion energy enters the body, the location where the Bragg peak occurs remains fixed at a specific depth. Therefore, when the tumor's position shifts due to respiratory movement, it can cause an accumulation of radiation dose from carbon ions at the wrong location, leading to a dual loss in treatment - where the treatment fails to reach the intended area while causing harmful radiation to unintended areas. Respiratory motion is a major factor affecting the positioning of thoracoabdominal tumors during radiation therapy. The relationship between tumor motion and respiratory motion is closely intertwined, with their cycles and amplitudes being fundamentally synchronized. Therefore, in the absence of other interfering factors, tumor motion can be attributed mainly to respiratory motion [ 8 ]. Due to the influence of motion on the diaphragm during respiration, tumors located in the lower lung and upper abdomen are more prone to moving "off-target", which suggests that tumors can move up to 50 mm off target [ 9 ]. Such off-target movement can result in underdosing of the target area and overdosing of normal tissues, significantly impacting treatment efficacy and prognosis. Previous studies have shown that the displacement of the geometric center of the target area due to respiratory motion in the left-right, anterior-posterior, and cranio-caudal directions is 0.34 ± 0.21, 0.21 ± 0.27, and 0.84 ± 0.42 cm, respectively [ 10 , 11 ]. These studies collectively highlight the significance of organ movement caused by respiratory motion, especially of thoracoabdominal tumors. The impact of respiratory motion during tumor radiotherapy cannot be underestimated, and precise radiation therapy can only be achieved by minimizing the effects of respiratory motion. Therefore, numerous researchers have explored methods to mitigate the impact of tumor movement due to respiratory motion. The methods for reducing the influence of respiratory motion can be broadly categorized into five groups: motion-encompassing techniques, breath-holding techniques, forced shallow breathing techniques, respiratory gating techniques, and real-time motion tracking techniques, each with its own advantages and disadvantages. To control respiratory motion during heavy ion therapy, we introduced HFOV technology for heavy ion therapy. Analysis of the data from 30 patients showed vital signs were stable. Respiratory motion under HFOV was 1.33 ± 0.39 mm, which was significantly less than that during spontaneous breathing and there was no "off-target" movement during radiation therapy. Therefore, when the target area is set, ITV can be ignored, and the positioning error of patients is reduced to 1-3mm due to respiratory control, and PTV only needs to be expanded by 1-3mm on the basis of GTV. When there is no breathing control, GTV expands outward by 8-10mm to form ITV, and the positioning error of ITV expands outward by 5-8mm to form PTV[ 12 ]. Therefore, heavy ion therapy under the control of high-frequency oscillatory breathing can reduce the unnecessary external emission boundary of PTV, control and narrow the target area, reduce the irradiation dose of normal tissues within the target area, and reduce the damage to normal healthy tissues. In the course of treatment, the incidence of adverse reactions was low and mild. Radiation pneumonia occurred in 1 of the 30 patients, which was significantly lower than that reported previously (15%-40% ) [ 13 , 14 ]. All these further indicated that the HFOV breathing control technology significantly reduced the damage of healthy lung tissues and was relatively safer. It was related to precise tumor targeting by minimizing irradiation on normal tissues with HFOV controlled respiration movement during heavy ion therapy, Moreover, it allowed for simultaneous irradiation of multiple lesions in a single session, thereby reducing the patients’ hospitalization duration and economic burden. Hence, the use of HFOV for respiration control in carbon ion therapy can achieve the requirement for high precision, efficiency, and dose accumulation at the tumor site. There were several limitations in this study. First of all, this is a retrospective study, and the inherent limitation of the retrospective study would affect the conclusion. Secondly, the current study has only involved 30 cases, which presents a limited sample size. The third, there were no comparisons with other ventilation modes. Therefore, a well designed RCT is needed to confirm the discoveries. In summary, the use of HFOV controlled chest movement in thoracic and abdominal tumor heavy ion therapy could ensure high safety. This technology enables patients to receive precise heavy ion treatment with accurate positioning, high tumor radiation dosage, and minimal exposure to normal tissues. More studies are needed in future treatments. Declarations Declaration of conflicting interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Funding This research work was supported by the Gansu Health Industry Scientific Research Plan, and the funding project number is GSWSQN2023-20. Ethics approval and consent to participate This study was conducted in accordance with ethical guidelines, the study protocol was approved by the Wuwei Tumor Hospital Medical Ethics Committee(2023-31).All participants provided informed consent to participate in this study. Consent for publication Not applicable for this section. Availability of data and materials Data are not publicly available due to its sensitive nature (including protected health information of participants.) De-identifed data may be made available upon reasonable request to the corresponding author for the purposes of replication of study results. Author contributions Conception and design: YW, YZW, WXZ,YSZ. Collection and assembly of data: YW, YZW, WXZ,YTT. Data analysis and interpretation:YW, YZW, WXZ,YTT,FW. Manuscript writing: All authors. Final approval of manuscript: All authors. Accountable for all aspects of the work: All authors. References Wen-Chi Yang, Feng-Ming Hsu and Pan-Chyr Yang. Precision radiotherapy for non-small cell lung cancer. J Biomed Sci, 2020. 27(1):82. Wang R, Liang XK, Zhu XY, et al. A Feasibility of Respiration Prediction Based on Deep Bi-LSTM for Real-Time Tumor Tracking. IEEE Access: 2018, 6: 51262-51268 Tsujii H，Kamada T，Shirai T，et al. Carbon-ion radiotherapy： principles，practices，and treatment planning[M]. Tokyo： Springer，2014. Hupp, Susan R , D. A. Turner , and K. J. Rehder . Is there still a role for high-frequency oscillatory ventilation in neonates, children and adults? Expert Review of Respiratory Medicine .2015. 9(5): 1-16. Jung-in Kim, Hanyoung Lee, Hong-Gyun Wu, et al. Development of Patient-Controlled Respiratory Gating System Based on Visual Guidance for Magnetic-Resonance Image-Guided Radiation Therapy[J]. Med Phys. 2017, 44(9): 4838-4846. Philip Keith , L Keith Scott , Linda Perkins,et al.High-Frequency Oscillatory Ventilation for Refractory Hypoxemia in Severe COVID-19 Pneumonia: A Small Case Series.Am J Case Rep. 2022 Jun 22;23:e936651. Yanshan Zhang，Xiaojun Li，Yihe Zhang,et al.Non-invasive high frequency oscillatory ventilation inhibiting respiratory motion in healthy volunteers. Sci Rep, 2022. 12(1): 22604. Farzaneh Mohammad Javad Keikhai,Nasseri Shahrokh, Momennezhad Mehdi, et al. esign and Construction of A Laser-Based Respiratory Gating System For Implementation of Deep Inspiration Breathe Hold Technique in Radiotherapy Clinics. [J] Med Signals Sens. 2018; 8(4): 253-262. Shi Chengyu,Tang Xiaoli, Chan Maria, Evaluation of the new respiratory gating system. Precision radiation oncology. 2017; 1(4): 127-133. KUO CC，CHUANG HC，LIAO AH，et al．Fast Fourier transform combined with phase leading compensator for respiratory motion compensation system［J］．Quant Imaging Med Surg，2020，10(5):907－920． QI Y J，LI JB，ZHANG YJ，et al．The effectiveness of abdominal compression in the target movement and external extension bound ary of peripheral pulmonary tumors treated with stereotactic radio therapy based on 4DCT［J］．Chin JＲadiol Med Prot，2021，41 (2):134－139． Chinese Society of Radiation Oncologists, Chinese Medical Doctor Association of Radiation Oncologists, Chinese Anti-Cancer Association of Radiation Therapy Professional Committee, et al. Chinese Clinical Guidelines for radiation therapy for non-small cell lung Cancer (2020 edition) [J]. Chinese Journal of Radiation Oncology,2020,29 (08): 599-607. Liu Yafeng, Wu Jing, Zhou Jiawei,et al．Construction and Verification of a Radiation Pneumonia Prediction Model Based on Multiple Parameters.Cancer Control,2021 Jan-Dec (28): 1-9. Stahl JM, Corso CD, Verma V, et al. Trends in stereotactic body radiation therapy for stage I small cell lung cancer. Lung Cancer. 2017;103(2):11–16. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4315900","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":297828141,"identity":"1e60d78d-1001-4c77-8e5d-dd6f0f94ea34","order_by":0,"name":"Yi Wang","email":"","orcid":"","institution":"Wuwei Tumor Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yi","middleName":"","lastName":"Wang","suffix":""},{"id":297828142,"identity":"4ba787a0-e283-4d0b-94e5-e833ff9ae009","order_by":1,"name":"Wenxue Zhao","email":"","orcid":"","institution":"Wuwei Tumor Hospital","correspondingAuthor":false,"prefix":"","firstName":"Wenxue","middleName":"","lastName":"Zhao","suffix":""},{"id":297828146,"identity":"ceeedc67-2294-4ace-9482-7db8cf483818","order_by":2,"name":"Yutian Tang","email":"","orcid":"","institution":"Wuwei Tumor Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yutian","middleName":"","lastName":"Tang","suffix":""},{"id":297828149,"identity":"ce7a3b5c-f9bf-45de-bf5f-40c48d6395ff","order_by":3,"name":"Fang Wang","email":"","orcid":"","institution":"Wuwei Tumor Hospital","correspondingAuthor":false,"prefix":"","firstName":"Fang","middleName":"","lastName":"Wang","suffix":""},{"id":297828150,"identity":"a7f26e9a-2e22-484c-9942-cae78899d926","order_by":4,"name":"Yancheng Ye","email":"","orcid":"","institution":"Heavy Ion Center of Wuwei Tumor Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yancheng","middleName":"","lastName":"Ye","suffix":""},{"id":297828151,"identity":"5e87f7b7-a452-4733-a515-87fc2c9e26f7","order_by":5,"name":"Yanshan Zhang","email":"","orcid":"","institution":"Heavy Ion Center of Wuwei Tumor Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yanshan","middleName":"","lastName":"Zhang","suffix":""},{"id":297828154,"identity":"bff55170-8103-453f-8a22-69538438d151","order_by":6,"name":"Xiaojing Peng","email":"","orcid":"","institution":"Wuwei Tumor Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xiaojing","middleName":"","lastName":"Peng","suffix":""},{"id":297828156,"identity":"3015eadf-aa18-4329-99b4-e62f8fca78b6","order_by":7,"name":"Wenyuan Yang","email":"","orcid":"","institution":"Wuwei Tumor Hospital","correspondingAuthor":false,"prefix":"","firstName":"Wenyuan","middleName":"","lastName":"Yang","suffix":""},{"id":297828158,"identity":"5d95f8cb-1de0-48ce-b2ad-ac2959c730f8","order_by":8,"name":"Yanqing Sun","email":"","orcid":"","institution":"Wuwei Tumor Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yanqing","middleName":"","lastName":"Sun","suffix":""},{"id":297828159,"identity":"831def5a-f42e-49ef-aaf0-504fda8ff63e","order_by":9,"name":"Limei Niu","email":"","orcid":"","institution":"Wuwei Tumor Hospital","correspondingAuthor":false,"prefix":"","firstName":"Limei","middleName":"","lastName":"Niu","suffix":""},{"id":297828160,"identity":"22f6e500-9f40-45b3-8447-0c50990749b9","order_by":10,"name":"Yanzhi Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0UlEQVRIie3RsQrCMBCA4SuFdImdI0L6BEIlIAjisyQU6ujaMYLUlyi+hFAcowWnuHdwqEunLp11sG46NW6C+fePS+4AbLYfDHlyeX8kc4qgUGbEx6oiWMfMd87cjFAiKjLYnMTO1aHhw3DBw6FUDCHdlg0s6Fj2ES/lfHK4UoQv+1kGEZuq3imaK6FrhsglH2FQIu8lZNXKY1qINGhqU8IjZ/0ioJEhwSp2oVsygjObZaHBX4Kt7Eh3ykAWt7JJFrSXfESw4WneybfCZrPZ/qInCuNFjXeCeSUAAAAASUVORK5CYII=","orcid":"","institution":"Wuwei Tumor Hospital","correspondingAuthor":true,"prefix":"","firstName":"Yanzhi","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2024-04-24 06:30:00","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4315900/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4315900/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":56036700,"identity":"b3a5680b-0954-495e-b9b0-231bc1d66a01","added_by":"auto","created_at":"2024-05-07 18:46:52","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":36229,"visible":true,"origin":"","legend":"\u003cp\u003eNumber of tumor radiation foci\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4315900/v1/24970775ac4e273f1b05305b.png"},{"id":56036701,"identity":"5bedc1a5-698a-46f8-914b-c098f25121b2","added_by":"auto","created_at":"2024-05-07 18:46:52","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1267839,"visible":true,"origin":"","legend":"\u003cp\u003e4-DCT of a typical patients with spontaneous breathing (a and b, diaphragm movement 21.50 mm) and with HFOV (c and d, diaphragm movement 1.50 mm)\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4315900/v1/2ced11697bcfa2e875e79152.png"},{"id":56035620,"identity":"93dc64fb-3fc0-4b2f-9802-1df0ebe992c2","added_by":"auto","created_at":"2024-05-07 18:38:52","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":99392,"visible":true,"origin":"","legend":"\u003cp\u003eDiaphragm movement during spontaneous breath \u003cem\u003evs \u003c/em\u003eduring HFOV\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-4315900/v1/ae8f0204c243419c3f59d0fc.png"},{"id":56035618,"identity":"d3fcb24e-ca6e-48f0-b004-9d5fa78aa8d8","added_by":"auto","created_at":"2024-05-07 18:38:52","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":24485,"visible":true,"origin":"","legend":"\u003cp\u003eEfficacy evaluation\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-4315900/v1/121e3287ed0c4555cd40a600.png"},{"id":58338577,"identity":"0c644804-ac11-4519-a260-49ac839d4f01","added_by":"auto","created_at":"2024-06-14 06:14:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3470585,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4315900/v1/f14da2f7-1526-49a6-a4f5-c91b66861c3d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Safety and feasibility of High-Frequency Oscillatory Ventilation for the control respiratory movement in patients with Thoracoabdominal Tumors receiving Heavy Ion precision Therapy","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe incidence of tumors is increasing annually, seriously affecting human health. Surgery and radiotherapy are important treatment modalities for malignant tumors, with approximately 70% of cancer treatment regimens involving radiation therapy. The principle behind radiation therapy is to reduce the size of the tumor area by disrupting cell division through radiation. However, during radiotherapy, it is also possible to affect healthy cells [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHeavy ion therapy is currently the most advanced technology for tumor radiation therapy. Heavy ion beams are high-LET radiation that benefit physical dose distribution (Bragg peak). There is a minimal risk of exposure to organs located beyond the range endpoint, high biological efficacy in the peak region, and significant therapeutic effects have been achieved in the clinical treatment of tumors thus far [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. However, the location of thoracoabdominal tumors changes with respiratory motion during treatment, posing a challenge as respiratory motion can cause deviations in the position of the radiation therapy target relative to the accelerator's static irradiation field [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Respiratory motion is one of the important factors affecting the efficacy of \"precision radiation therapy\" for thoracic tumors. The relative position between the scatter beam and the target area changes as a result of motion during irradiation, leading to inconsistencies between the actual dose received by the patient and the planned dose [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. This seriously affects the precision of heavy ion radiation therapy for tumor sites and results in unnecessary damage to healthy tissues. Therefore, there is an urgent clinical need for a safe and effective means of controlling respiratory motion during heavy ion therapy.\u003c/p\u003e \u003cp\u003eHigh-frequency oscillatory ventilation (HFOV) characterized with a high frequency, small tidal volume, and adequate mean airway pressure may limit patient's respiratory movements during ventilation [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Theoretically, it is an ideal approach to control the respiratory movement during therapy and make the precise heavy ion therapy possible. Under the basis of preliminary tests involving healthcare professionals and volunteers in our center demonstrating the safety of HFOV, we pioneered the application of HFOV in the treatment of thoracoabdominal tumors subjected to heavy ion therapy.. Currently, this technology has been successfully applied in the treatment of 30 cases. We retrospectively analyzed the clinical data of these 30 patients and discussed the value of HFOV technology in heavy ion therapy, providing insights and references for precision radiation therapy.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eGeneral Information\u003c/h2\u003e \u003cp\u003e This study was approved by the ethic committee of clinical research from Wuwei Cancer Hospital. Clinical data were retrospectively analyzed for patients with thoracoabdominal tumors who underwent HFOV-controlled heavy ion therapy at Gansu Province Wuwei Cancer Hospital from January 2023 to March 2024. All patients had been previously diagnosed with malignant tumors at other hospitals and had undergone systemic antitumor treatment. The enrolled patients were generally in good condition, without contraindications to radiation therapy, and without current history of severe pulmonary and cardiac dysfunction, severe hypertension, cardiac arrhythmias, refractory hypotension, passive dependence on pulmonary blood flow, acute exacerbation of respiratory and circulatory diseases, or allergies to analgesics or sedatives.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eInstruments and Monitoring\u003c/h2\u003e \u003cp\u003eHFOV was provided by the ventilator (CareFusion 3100B HFOV, California, USA).TCM Combi M transcutaneous oxygen/carbon dioxide tension monitoring device and bedside electrocardiogram monitor were used to monitor the vital signs. Bispectral index (BIS) monitor was applied to monitor the sedation level, and Train-of-four (TOF) neuromuscular stimulator was used for monitoring levels of paralysis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eTreatment Procedure\u003c/h2\u003e \u003cp\u003eHFOV was used to control the respiration in patients under deep sedation (with etomidate and sufentanil) and adequate muscle relaxation (with rocuronium bromide). Following cessation of spontaneous breathing, tracheal intubation was performed, and 4-D CT positioning was conducted under HFOV control. The initial settings for the HFOV were as follows: frequency 480\u0026ndash;600 cycles per minute (8\u0026ndash;10 Hz), mean airway pressure (Paw) 10 cmH2O, amplitude 6 cm, tidal volume (Vt) 62.5 ml (determined by amplitude and frequency), inspiratory time 30%, fraction of inspired oxygen (FiO2) 40%, and bias flow 30 L/min. This ensured adequate airway pressure, oxygen saturation, tidal volume, oxygen partial pressure, and carbon dioxide partial pressure. After positioning, patients were transferred to the intensive care unit (ICU) for assisted ventilation with a conventional ventilator while awaiting target area delineation. After target area delineation, patients were transported to the heavy ion therapy room for heavy ion therapy under HFOV control. Following completion of heavy ion therapy, patients were transferred back to the ICU, awakened, extubated upon restoration of spontaneous breathing, and then sent to a general ward. Throughout the procedure, PO2 and PCO2 levels were continuously monitored, and the BIS 、modified observer\u0026rsquo;s assessment of alert (MOAA/S) 、Ramsay score and Richmond Agitation and sedation scale(RASS), and TOF were maintained suitable levels to ensure patient comfort and safety.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eEvaluation Criteria\u003c/h2\u003e \u003cp\u003eThe patients' heart rate (P), blood pressure (mean arterial pressure, MAP), oxygen saturation (SO2), transcutaneous oxygen tension (tcpO2), transcutaneous carbon dioxide tension (tcpCO2), diaphragm movement, subjective feelings during the 2-48-hour post-treatment period, and general condition were monitored. Late-phase side effects and efficacy were also assessed.\u003c/p\u003e \u003cp\u003eAccording to the solid Tumor Efficacy Evaluation Criteria (RECIST)[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], the patients' efficacy was evaluated. Complete response (CR) was defined as the disappearance of all target lesions.Partial response (PR) was defined as a reduction of at least 30% in the sum of the longest diameters of the target lesions compared to baseline status.Stable lesion (SD) is defined as somewhere between partial remission and disease progression.Objective response rate(ORR) was generally defined as the sum of complete response plus partial response\u003c/p\u003e \u003cp\u003e \u003cb\u003eStatistical Analysis;\u003c/b\u003e \u003c/p\u003e \u003cp\u003eAll statistical analyses were performed using SPSS version 26.0. Normally distributed data are presented as the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, and non-normally distributed data are presented as the median (range). Student's t test was used for normally distributed data, and the Mann‒Whitney U test was used for non-normally distributed data. ANOVA was use to compare the repeated measures. A significance level of P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eGeneral Clinical Data;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 30 patients was included. Among them, 19 were male and 11were female with a median age of 54.5 years (range: 35\u0026ndash;81 years). 12 had secondary lung malignancies, 7 had primary lung malignancies, 6 had pancreatic malignancies,3 had liver malignancies, 1 had secondary liver malignancies, 1 had intrahepatic bile duct malignancy, and 1 had breast malignancy. Eighteen radiation sites were located in the lungs, 6 in the pancreas, 4 in livers, 1 in the intrahepatic bile duct, and 1 in the breast, as detailed in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. Primary and liver tumors often presented with multiple lesions, with one patient having 11 metastatic lesions in the left lung. Treatment was completed in a single session for patients with multiple lesions, as illustrated in Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u0026nbsp;\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCharacteristics of patients\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNo.\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDiagnosis\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSite of the radiation\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNo.\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDiagnosis\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSite of the radiation\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMalignant tumor of the liver\u003c/p\u003e\n \u003cp\u003eSecondary malignant tumor of the lung\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLeft Lung\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMalignant tumor of the colon\u003c/p\u003e\n \u003cp\u003eSecondary malignant tumor of the lung\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLeft Lung\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMalignant tumor of the colon\u003c/p\u003e\n \u003cp\u003eSecondary malignant tumor of the lung\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLeft Lung\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMalignant tumor of the lung\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLeft Lung\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMalignant tumor of the liver\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSecondary malignant tumor of the lung\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eRight Lung\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e18\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCervical malignancy\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSecondary malignant tumor of the lung\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eRight Lung\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMalignant tumor of the lung\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLeft Lung\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e19\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePancreatic malignancy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePancreas\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eRectocolonic malignancy\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSecondary malignant tumor of the lung\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLeft Lung\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e20\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMalignant tumor of the liver\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSecondary malignant tumor of the lung\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLeft Lung\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePancreatic malignancy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003epancreas\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e21\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMalignant tumor of the liver\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLiver\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePancreatic malignancy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003epancreas\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e22\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMalignant tumor of the liver\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLiver\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePancreatic malignancy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003epancreas\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e23\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePancreatic malignancy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003epancreas\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntrahepatic bile duct malignancy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntrahepatic bile duct\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e24\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMalignant tumor of colon\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSecondary malignant tumor of\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLiver\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e10\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePancreatic malignancy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003epancreas\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e25\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMalignant tumor of the lung\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eRight Lung\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e11\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGastric malignancy\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSecondary malignant tumor of the lung\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLeft Lung\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e26\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMalignant tumor of the liver\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLiver\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e12\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eBreast malignancy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eRight mammary gland\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e27\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMalignant tumor of the colon\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSecondary malignant tumor of the lung\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eRight Lung\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e13\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLung malignancy tumor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eRight Lung\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e28\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMalignant tumor of the lung\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eRight Lung\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e14\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eBile duct malignancy\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSecondary malignant tumor of the lung\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eRight Lung\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e29\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMalignant tumor of the lung\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eBoth lungs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMalignant tumor of the lung\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eRight Lung\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e30\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eBile duct malignancy\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSecondary malignant tumor of lun\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLeft Lung\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eChanges of vital signs during the Treatment Period;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnalysis of monitoring parameters during the treatment period indicated that there was no statistically significant difference (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) in heart rate, blood pressure, or blood oxygen saturation before, during, or after treatment. Additionally, there was no statistically significant difference (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) in tcpCO2 values before, during or after treatment. In addition, tcpO2 values during treatment were significantly higher than those before and after treatment (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), as detailed in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u0026nbsp;\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eChanges of vital signs during treatment\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eParameters\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBaseline\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAfter Intubation\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLocation10 min\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLocation 30 min\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTarget volume delineation\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e10 mins after heavy ion therapy\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e30 mins After heavy ion therapy\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAfter extubation\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP value with repeat measure\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP(beats/min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e77.60\u0026thinsp;\u0026plusmn;\u0026thinsp;10.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e73.07\u0026thinsp;\u0026plusmn;\u0026thinsp;8.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e74.20\u0026thinsp;\u0026plusmn;\u0026thinsp;8.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e74.27\u0026thinsp;\u0026plusmn;\u0026thinsp;7.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e76.60\u0026thinsp;\u0026plusmn;\u0026thinsp;8.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e75.97\u0026thinsp;\u0026plusmn;\u0026thinsp;9.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e77.77\u0026thinsp;\u0026plusmn;\u0026thinsp;8.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e76.30\u0026thinsp;\u0026plusmn;\u0026thinsp;8.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.339\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMAP(mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e80.43\u0026thinsp;\u0026plusmn;\u0026thinsp;8.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e79.970\u0026thinsp;\u0026plusmn;\u0026thinsp;8.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e81.67\u0026thinsp;\u0026plusmn;\u0026thinsp;8.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e78.40\u0026thinsp;\u0026plusmn;\u0026thinsp;8.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e80.47\u0026thinsp;\u0026plusmn;\u0026thinsp;7.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e81.53\u0026thinsp;\u0026plusmn;\u0026thinsp;11.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e83.67\u0026thinsp;\u0026plusmn;\u0026thinsp;7.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e81.00\u0026thinsp;\u0026plusmn;\u0026thinsp;7.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.470\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSO\u003csub\u003e2\u003c/sub\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e96.27\u0026thinsp;\u0026plusmn;\u0026thinsp;1.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e96.70\u0026thinsp;\u0026plusmn;\u0026thinsp;1.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e97.13\u0026thinsp;\u0026plusmn;\u0026thinsp;2.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e96.53\u0026thinsp;\u0026plusmn;\u0026thinsp;2.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e96.57\u0026thinsp;\u0026plusmn;\u0026thinsp;1.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e96.77\u0026thinsp;\u0026plusmn;\u0026thinsp;1.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e96.63\u0026thinsp;\u0026plusmn;\u0026thinsp;1.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e96.53\u0026thinsp;\u0026plusmn;\u0026thinsp;1.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.7797\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003etcpO\u003csub\u003e2\u003c/sub\u003e(mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e89.93\u0026thinsp;\u0026plusmn;\u0026thinsp;6.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e97.57\u0026thinsp;\u0026plusmn;\u0026thinsp;3.36\u003csup\u003e*#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e97.00\u0026thinsp;\u0026plusmn;\u0026thinsp;3.86\u003csup\u003e*#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e96.83\u0026thinsp;\u0026plusmn;\u0026thinsp;4.33\u003csup\u003e*#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e96070\u0026thinsp;\u0026plusmn;\u0026thinsp;4.43\u003csup\u003e*#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e97.50\u0026thinsp;\u0026plusmn;\u0026thinsp;5.41\u003csup\u003e*#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e97.03\u0026thinsp;\u0026plusmn;\u0026thinsp;3.61\u003csup\u003e*#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e92.70\u0026thinsp;\u0026plusmn;\u0026thinsp;5.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003etcpCO\u003csub\u003e2\u003c/sub\u003e(mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e43.97\u0026thinsp;\u0026plusmn;\u0026thinsp;4.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e45.73\u0026thinsp;\u0026plusmn;\u0026thinsp;2.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e45.77\u0026thinsp;\u0026plusmn;\u0026thinsp;3.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e46.83\u0026thinsp;\u0026plusmn;\u0026thinsp;2.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e45.63\u0026thinsp;\u0026plusmn;\u0026thinsp;3.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e45.90\u0026thinsp;\u0026plusmn;\u0026thinsp;5.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e46.87\u0026thinsp;\u0026plusmn;\u0026thinsp;7.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e44.20\u0026thinsp;\u0026plusmn;\u0026thinsp;5.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.116\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eCompared with baseline, *\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05; compared with extubation, #\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eComparison of Respiratory Motion between spontaneous respiration and HFOV\u003c/h2\u003e\n \u003cp\u003eAll 30 patients underwent 4-D CT scans in both spontaneous respiration and controlled respiratory (HFOV) status. Respiratory motion was measured with diaphragm movement in both status. In one typical patientm the diaphragm motion was 21.50mm under spontaneous breathing and 1.50mm under HFOV, as depicted in Fig. 2.It was observed that respiratory motion during HFOV was 1.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.39mm, which was significantly lower than that during spontaneous breathing (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), as depicted in Table 3and Fig. \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e. The \u0026quot;off-target\u0026quot; phenomenon is that the tumor moves out of the irradiation field and does not get enough radiation dose, 30 patients did not occur \u0026quot;off-target\u0026quot; phenomenon\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDiaphragm movement during spontaneous breathing and HFOV\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDiaphragm movement during spontaneous breath (mm)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDiaphragm movement during HFOV(mm)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP值\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.31\u0026thinsp;\u0026plusmn;\u0026thinsp;4.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003eFigure 2 4-DCT of a typical patients with spontaneous breathing (a and b, diaphragm movement 21.50 mm) and with HFOV (c and d, diaphragm movement 1.50 mm)\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n \u003ch2\u003eSide Effects during and after Heavy Ion Therapy under HFOV\u003c/h2\u003e\n \u003cp\u003eDuring the treatment process, one patient experienced hypertension, which was successfully managed with medication to normalize blood pressure. Another patient developed hypercapnia; however, this was primarily influenced by oscillation amplitude and frequency. After adjusting the parameters of the ventilator (increasing amplitude and decreasing frequency to increase tidal volume), the carbon dioxide partial pressure gradually returned to normal. Two patients experienced nausea and vomiting after extubation, which was most likely due to insufficient fasting time before treatment or the effects of analgesics and sedatives. Symptomatic treatment was administered and led to improvement.\u003c/p\u003e\n \u003cp\u003eRadiation pneumonia occurred in 1 of the 30 patients, and the mean hospital stay was 22.13\u0026thinsp;\u0026plusmn;\u0026thinsp;10.94 days. For pancreatic malignancies and intrahepatic bile duct malignancies, conventional heavy ion treatment was followed by intensive heavy ion treatment under high-frequency oscillation breathing control, so the hospital stay was longer.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n \u003ch2\u003eEfficacy evaluation\u003c/h2\u003e\n \u003cp\u003e1 patient did not reach the evaluation time during follow-up, and other 29 patients\u0026apos; efficacy was followed. Complete response (CR) was found in 12 cases (41.37%), partial response (PR) in 15 cases (51.72%), stable disease (SD) in 2 cases (6.90%), and objective response rate (ORR) was 93.10%, as shown in Table 4and Fig. \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e. Up to the follow-up date, no death occurred in 30 patients.\u0026nbsp;\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003e29 Evaluation of curative effect in 29 patients\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eEfficacy\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eORR\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003en(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12(41.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15(51.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2(6.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0(0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27(93.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study demonstrated that HFOV controlled respiration during heavy iron radiation therapy was safety with stable hemodynamics and gas exchange. In addition, HFOV could significantly decreased the diaphragm movement, which was ideal for tumor location during radiation therapy. This is the first study to show the safety and efficacy of HFOV during heavy iron therapy.\u003c/p\u003e \u003cp\u003eThe heavy ion therapy has two major advantages compared to traditional photon therapy. One is the advantage of the Bragg peak physics, and the other is the relative radiation biological effect. The Bragg peak's occurrence in the depth of the biological body is highly sensitive to the entry of carbon ions, meaning that once a certain amount of carbon ion energy enters the body, the location where the Bragg peak occurs remains fixed at a specific depth. Therefore, when the tumor's position shifts due to respiratory movement, it can cause an accumulation of radiation dose from carbon ions at the wrong location, leading to a dual loss in treatment - where the treatment fails to reach the intended area while causing harmful radiation to unintended areas.\u003c/p\u003e \u003cp\u003eRespiratory motion is a major factor affecting the positioning of thoracoabdominal tumors during radiation therapy. The relationship between tumor motion and respiratory motion is closely intertwined, with their cycles and amplitudes being fundamentally synchronized. Therefore, in the absence of other interfering factors, tumor motion can be attributed mainly to respiratory motion [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Due to the influence of motion on the diaphragm during respiration, tumors located in the lower lung and upper abdomen are more prone to moving \"off-target\", which suggests that tumors can move up to 50 mm off target [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Such off-target movement can result in underdosing of the target area and overdosing of normal tissues, significantly impacting treatment efficacy and prognosis.\u003c/p\u003e \u003cp\u003ePrevious studies have shown that the displacement of the geometric center of the target area due to respiratory motion in the left-right, anterior-posterior, and cranio-caudal directions is 0.34 ± 0.21, 0.21 ± 0.27, and 0.84 ± 0.42 cm, respectively [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. These studies collectively highlight the significance of organ movement caused by respiratory motion, especially of thoracoabdominal tumors. The impact of respiratory motion during tumor radiotherapy cannot be underestimated, and precise radiation therapy can only be achieved by minimizing the effects of respiratory motion.\u003c/p\u003e \u003cp\u003eTherefore, numerous researchers have explored methods to mitigate the impact of tumor movement due to respiratory motion. The methods for reducing the influence of respiratory motion can be broadly categorized into five groups: motion-encompassing techniques, breath-holding techniques, forced shallow breathing techniques, respiratory gating techniques, and real-time motion tracking techniques, each with its own advantages and disadvantages.\u003c/p\u003e \u003cp\u003eTo control respiratory motion during heavy ion therapy, we introduced HFOV technology for heavy ion therapy. Analysis of the data from 30 patients showed vital signs were stable. Respiratory motion under HFOV was 1.33 ± 0.39 mm, which was significantly less than that during spontaneous breathing and there was no \"off-target\" movement during radiation therapy. Therefore, when the target area is set, ITV can be ignored, and the positioning error of patients is reduced to 1-3mm due to respiratory control, and PTV only needs to be expanded by 1-3mm on the basis of GTV. When there is no breathing control, GTV expands outward by 8-10mm to form ITV, and the positioning error of ITV expands outward by 5-8mm to form PTV[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Therefore, heavy ion therapy under the control of high-frequency oscillatory breathing can reduce the unnecessary external emission boundary of PTV, control and narrow the target area, reduce the irradiation dose of normal tissues within the target area, and reduce the damage to normal healthy tissues.\u003c/p\u003e \u003cp\u003eIn the course of treatment, the incidence of adverse reactions was low and mild. Radiation pneumonia occurred in 1 of the 30 patients, which was significantly lower than that reported previously (15%-40% ) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. All these further indicated that the HFOV breathing control technology significantly reduced the damage of healthy lung tissues and was relatively safer. It was related to precise tumor targeting by minimizing irradiation on normal tissues with HFOV controlled respiration movement during heavy ion therapy, Moreover, it allowed for simultaneous irradiation of multiple lesions in a single session, thereby reducing the patients’ hospitalization duration and economic burden. Hence, the use of HFOV for respiration control in carbon ion therapy can achieve the requirement for high precision, efficiency, and dose accumulation at the tumor site.\u003c/p\u003e \u003cp\u003eThere were several limitations in this study. First of all, this is a retrospective study, and the inherent limitation of the retrospective study would affect the conclusion. Secondly, the current study has only involved 30 cases, which presents a limited sample size. The third, there were no comparisons with other ventilation modes. Therefore, a well designed RCT is needed to confirm the discoveries.\u003c/p\u003e \u003cp\u003eIn summary, the use of HFOV controlled chest movement in thoracic and abdominal tumor heavy ion therapy could ensure high safety. This technology enables patients to receive precise heavy ion treatment with accurate positioning, high tumor radiation dosage, and minimal exposure to normal tissues. More studies are needed in future treatments.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDeclaration of conflicting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research work was supported by the Gansu Health Industry Scientific Research Plan, and the funding project number is GSWSQN2023-20.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with ethical guidelines, the study protocol was approved by the Wuwei Tumor Hospital Medical Ethics Committee(2023-31).All participants provided informed consent to participate in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ch4\u003eNot applicable\u0026nbsp;for this section.\u003c/h4\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData are not publicly available due to its sensitive nature (including protected health information of participants.) De-identifed data may be made available upon reasonable request to the corresponding author for the purposes of replication of study results.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConception and design: YW, YZW, WXZ,YSZ. Collection and assembly of data: YW, YZW, WXZ,YTT. Data analysis and interpretation:YW, YZW, WXZ,YTT,FW. Manuscript writing: All authors. Final approval of manuscript: All authors. Accountable for all aspects of the work: All authors.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWen-Chi Yang, Feng-Ming Hsu and Pan-Chyr Yang. Precision radiotherapy for non-small cell lung cancer. J Biomed Sci, 2020. 27(1):82.\u003c/li\u003e\n\u003cli\u003eWang R, Liang XK, Zhu XY, et al. A Feasibility of Respiration Prediction Based on Deep Bi-LSTM for Real-Time Tumor Tracking. IEEE Access: 2018, 6: 51262-51268\u003c/li\u003e\n\u003cli\u003eTsujii H，Kamada T，Shirai T，et al. Carbon-ion radiotherapy： principles，practices，and treatment planning[M]. Tokyo： Springer，2014.\u003c/li\u003e\n\u003cli\u003eHupp, Susan R , D. A. Turner , and K. J. Rehder . Is there still a role for high-frequency oscillatory ventilation in neonates, children and adults? Expert Review of Respiratory Medicine .2015. 9(5): 1-16.\u003c/li\u003e\n\u003cli\u003eJung-in Kim, Hanyoung Lee, Hong-Gyun Wu, et al. Development of Patient-Controlled Respiratory Gating System Based on Visual Guidance for Magnetic-Resonance Image-Guided Radiation Therapy[J]. Med Phys. 2017, 44(9): 4838-4846.\u003c/li\u003e\n\u003cli\u003ePhilip Keith , L Keith Scott , Linda Perkins,et al.High-Frequency Oscillatory Ventilation for Refractory Hypoxemia in Severe COVID-19 Pneumonia: A Small Case Series.Am J Case Rep. 2022 Jun 22;23:e936651.\u003c/li\u003e\n\u003cli\u003eYanshan Zhang，Xiaojun Li，Yihe Zhang,et al.Non-invasive high frequency oscillatory ventilation inhibiting respiratory motion in healthy volunteers. Sci Rep, 2022. 12(1): 22604.\u003c/li\u003e\n\u003cli\u003eFarzaneh Mohammad Javad Keikhai,Nasseri Shahrokh, Momennezhad Mehdi, et al. esign and Construction of A Laser-Based Respiratory Gating System For Implementation of Deep Inspiration Breathe Hold Technique in Radiotherapy Clinics. [J] Med Signals Sens. 2018; 8(4): 253-262.\u003c/li\u003e\n\u003cli\u003eShi Chengyu,Tang Xiaoli, Chan Maria, Evaluation of the new respiratory gating system. Precision radiation oncology. 2017; 1(4): 127-133.\u003c/li\u003e\n\u003cli\u003eKUO CC，CHUANG HC，LIAO AH，et al．Fast Fourier transform combined with phase leading compensator for respiratory motion compensation system［J］．Quant Imaging Med Surg，2020，10(5):907－920．\u003c/li\u003e\n\u003cli\u003eQI Y J，LI JB，ZHANG YJ，et al．The effectiveness of abdominal compression in the target movement and external extension bound ary of peripheral pulmonary tumors treated with stereotactic radio therapy based on 4DCT［J］．Chin JＲadiol Med Prot，2021，41 (2):134－139．\u003c/li\u003e\n\u003cli\u003eChinese Society of Radiation Oncologists, Chinese Medical Doctor Association of Radiation Oncologists, Chinese Anti-Cancer Association of Radiation Therapy Professional Committee, et al. Chinese Clinical Guidelines for radiation therapy for non-small cell lung Cancer (2020 edition) [J]. Chinese Journal of Radiation Oncology,2020,29 (08): 599-607.\u003c/li\u003e\n\u003cli\u003eLiu Yafeng, Wu Jing, Zhou Jiawei,et al．Construction and Verification of a Radiation Pneumonia Prediction Model Based on Multiple Parameters.Cancer Control,2021 Jan-Dec (28): 1-9.\u003c/li\u003e\n\u003cli\u003eStahl JM, Corso CD, Verma V, et al. Trends in stereotactic body radiation therapy for stage I small cell lung cancer. Lung Cancer. 2017;103(2):11\u0026ndash;16.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"High-frequency oscillation ventilation, Breathing control, Heavy ions, Precision radiotherapy, Thoracic and abdominal tumors","lastPublishedDoi":"10.21203/rs.3.rs-4315900/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4315900/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction;\u003c/h2\u003e \u003cp\u003eThe aim of this study was to investigate the safety and feasibility of the high-frequency oscillatory ventilation (HFOV) technique for the management of respiratory motion in patients with thoracoabdominal malignancies undergoing heavy ion precision therapy.\u003c/p\u003e\u003ch2\u003eMethods;\u003c/h2\u003e \u003cp\u003eA retrospective analysis of clinical data from 30 patients with thoracoabdominal malignant tumors treated with heavy ion therapy under the control of high-frequency oscillatory ventilation at one Cancer Hospital was conducted from January 2023 to March 2024. Patient's general conditions, respiratory motion, and other clinical parameters were analyzed and compared before, during, and after the treatment to determine the value of utilizing HFOV for managing thoracoabdominal malignancies in patients undergoing heavy ion therapy.\u003c/p\u003e\u003ch2\u003eResults;\u003c/h2\u003e \u003cp\u003eThere was no significant difference in heart rate, blood pressure, blood oxygen saturation, or tcpCO2 before, during, or after treatment (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). In addition, HFOV improved the patient's tcpO2 values (\u003cem\u003eP\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.001). However, the lung respiratory motion under HFOV was 1.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.39 mm, which was significantly lower than that in the spontaneous respiration status (19.31\u0026thinsp;\u0026plusmn;\u0026thinsp;4.22mm, \u003cem\u003eP\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.001), and \"missed targeting\" was not observed during radiotherapy. Throughout the treatment process, one case complicated with hypertension and hypercapnia was observed, and two patients experienced nausea and vomiting after extubation. Radiation pneumonia occurred in 1 of 30 patients, and the mean hospital stay was 22.13\u0026thinsp;\u0026plusmn;\u0026thinsp;10.94 days. The results showed that the objective response rate was 93.1%, the complete response rate was 41.37%, and the partial response rate was 51.72%. No death occurred during the follow-up period.\u003c/p\u003e\u003ch2\u003eConclusion;\u003c/h2\u003e \u003cp\u003eHFOV is safety for thoracoabdominal tumor patients to receive high doses of precise heavy ion therapy, thereby enhancing treatment efficacy. Further randomized controlled trial is needed to confirm this discovery.\u003c/p\u003e","manuscriptTitle":"Safety and feasibility of High-Frequency Oscillatory Ventilation for the control respiratory movement in patients with Thoracoabdominal Tumors receiving Heavy Ion precision Therapy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-07 18:38:47","doi":"10.21203/rs.3.rs-4315900/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0cdb6d92-c724-474c-9700-0de6873f4fd6","owner":[],"postedDate":"May 7th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-06-14T06:06:04+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-07 18:38:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4315900","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4315900","identity":"rs-4315900","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}