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Take a deep breath. Hold it for 25 seconds. Exhale.

That simple act of holding a breath during radiation cancer treatment, called deep inspiration breath-hold (DIBH), could mean the difference between irradiating healthy tissue and sparing it, according to Neil Newman M.D, a radiation oncologist for Mays Cancer Center, home to UT Health San Antonio MD Anderson Cancer Center. Newman specializes in gastrointestinal cancers.

“It has major advantages. When you breathe, your bowels move, and you are moving your bowels closer to your tumor and radiation field, which could risk more side effects,” Newman said about gastrointestinal cancer treatment.

DIBH is used for women with breast cancer on the left side of their body. The breath hold moves the heart away from the tumor and the radiation treatment. Newman began using the technique on other eligible patients at the Mays Cancer Center.

“We know that higher doses yield better outcomes approaching surgery. Usually, the bowel limits the ability to go this high, but this technique can yield more room to dose escalate,” he said. “I like to offer higher doses when possible, and that only happens comfortably with DIBH.”

Cameras within the radiation treatment room at Mays Cancer Center monitor patients as they inhale and exhale. During each inhalation and hold, a machine beams radiation into the planned area of the body. When the patient exhales, the machine stops the treatment.

Patients in good physical condition are eligible to try the technique. Holding a breath for 25 to 30 seconds isn’t easy, so Newman gives his patients homework.

“I tell them, I want you to hold your breath for a certain amount of time three times a day. If you practice, your lungs will get better,” he said.

Practice sessions begin in a room at the Mays Cancer Center. When patients hold their breath, the room is lit green, indicating they are doing a good job. When they exhale, the room turns red. Newman said the practice sessions allow him to capture images of the position of tumors during the inhale. Then, he creates an individualized treatment plan.

“When the patient comes in for treatment, we take verification scans to ensure everything is in the same position as the practice sessions, and then we treat the patient,” Newman said.

Cruz Jimenez III, a physical therapist, was diagnosed with bile duct cancer in February 2023.

“My first thought was, ‘Wow.’ I was just stunned. I’m 59, I play racquetball, and I’m very active,” he said.

Bile ducts are thin tubes from the liver to the small intestine. They carry bile, a fluid created by the liver but stored in the gallbladder to help digest fats in foods. The disease is rare — only about 8,000 people are diagnosed each year. Jimenez’s cancer began in his bile ducts but quickly became a complicated case.

“Usually, bile duct cancers are in the liver or just outside the liver. Mr. Jimenez’s spread along the blood vessels near his pancreas to the middle of his body,” Newman said.

Survival rates range from 23% to 11%, depending on if the cancer is located inside or outside the liver.

Jimenez’s cancer was inside and outside. After his initial diagnosis, Jimenez was given nine to 12 months to live, so he and his wife planned a bucket list of trips across the country.

He went on a four-day trip to Las Vegas with his oldest daughter, took his brother on a tour of the Smithsonian museums in Washington, D.C., and skied with his wife in Ruidoso, N.M.

Jimenez was told by a doctor that there were very few options for treatment. Seeking a second opinion, Jimenez contacted the Mays Cancer Center.

“They said, ‘We feel like we can get it,’” Jimenez said.

The location of the tumor made it difficult to remove surgically, so Jimenez began aggressive radiation therapy using DIBH with Newman.

Jimenez was so good at holding his breath that he cut the time of his radiation treatments.

“I held my breath once for a minute and 45 seconds. The technicians told me, ‘Wow, we’re almost done,’” he said.

When Jimenez met Newman, his blood test biomarkers (CA19-9) were at 196, much higher than the normal range of less than 37.

After 15 treatments, his CA19-9 dropped to 11 with tumor shrinkage on CT scans.

“The radiation treatment totally inactivated the tumor,” Newman said.

By January, the radiation treatment had shrunk the inactive tumor small enough so it could be removed surgically. Now, well past the short life expectancy he was first given, Jimenez is recovering, though it’s slow and painful. The average recovery time is four to six months.

Jimenez said he is easily fatigued and suffering multiple effects of the surgery; however, he tries to stay active, renovating his son’s duplex.

“Working on the duplex gets me through the day. I feel so guilty and beat when I have to sit on the couch. But the pain reminds me I’m still here,” he said.

The Mays Cancer Center at UT Health San Antonio is one of only four National Cancer Institute-designated Cancer Centers in Texas. The Mays Cancer Center provides leading-edge cancer care, propels innovative cancer research and educates the next generation of leaders to end cancer in South Texas. To learn more, visit news.uthscsa.edu.