Comparison of Deep Inspiration Breath Hold Versus Free Breathing in Radiotherapy for Left Sided Breast Cancer

Overview

Journal Front Oncol

Specialty Oncology

Date 2022 May 9

PMID 35530354

Authors

Yongkai Lu

Di Yang

Xiaowei Zhang

Yonggang Teng

Wei Yuan

YueMei Zhang

Ruixin He

Fengwen Tang

Jie Pang

Bo Han

Ruijuan Chen

Yi Li

Affiliations

Soon will be listed here.

Abstract

Objectives: Modern breast cancer techniques, such as the deep inspiration breath-hold (DIBH) technique has been applied for left-sided breast cancer. Whether the DIBH regimen is the optimal solution for left-sided breast cancer remains unclear. This meta-analysis aims to elucidate the differences of DIBH and free-breathing (FB) for patients receiving radiotherapy for left-sided breast cancer and provide a practical reference for clinical practice.

Methods: Relevant research available on PubMed, Embase, Cochrane Library, and the Web of Science published before November 30, 2021 was independently and systematically examined by two investigators. Data were extracted from eligible studies for assessing their qualities and calculating the standardized mean difference (SMD) and 95% confidence intervals (CIs) using Review Manager software 5.4 (RevMan 5.4).

Results: Forty-one studies with a total of 3599 left-sided breast cancer patients were included in the meta-analysis. Compared with FB, DIBH reduced heart dose ( , , V30, V10, V5), left anterior descending branch (LAD) dose ( , ), ipsilateral lung dose ( , V20, V10, V5), and heart volume significantly. Lung volume increased greatly, and a statistically significant difference. For contralateral breast mean dose, DIBH has no obvious advantage over FB. The funnel plot suggested this study has no significant publication bias.

Conclusions: Although DIBH has no obvious advantage over FB in contralateral breast mean dose, it can significantly reduce heart dose, LAD dose, ipsilateral lung dose, and heart volume. Conversely, it can remarkably increase the ipsilateral lung volume. This study suggests that soon DIBH could be more widely utilized in clinical practice because of its excellent dosimetric performance.

Citing Articles

Surface-based deep inspiration breath-hold radiotherapy in left-sided breast cancer: final results from the SAVE-HEART study.

Schonecker S, Angelini L, Gaasch A, Zinn A, Konnerth D, Heinz C ESMO Open. 2024; 9(12):103993.

PMID: 39631360 PMC: 11655685. DOI: 10.1016/j.esmoop.2024.103993.

Enhancing positioning accuracy in adjuvant radiotherapy for left breast cancer using cervical-thoracic integrated bracket combined with deep inspiration breath holding.

Wan B, Liu Y, Ge Y, Liu F, Zhao R, Li T Thorac Cancer. 2024; 15(36):2540-2550.

PMID: 39520201 PMC: 11669448. DOI: 10.1111/1759-7714.15484.

Heart is a heavy burden: cardiac toxicity in radiation oncology.

Pouvreau P, Taleb I, Fontaine A, Edouard L, Gibson N, Yaouanq M Support Care Cancer. 2024; 32(11):769.

PMID: 39495349 DOI: 10.1007/s00520-024-08949-7.

Deep Inspiration Breath Hold in Left-Sided Breast Radiotherapy: A Balance Between Side Effects and Costs.

Busschaert S, Kimpe E, Gevaert T, De Ridder M, Putman K JACC CardioOncol. 2024; 6(4):514-525.

PMID: 39239337 PMC: 11372305. DOI: 10.1016/j.jaccao.2024.04.009.

Identification of variables and development of a prediction model for DIBH eligibility in left-sided breast cancer radiotherapy: a prospective cohort study with temporal validation.

Ahmad I, Chufal K, Miller A, Bajpai R, Umesh P, Sokhal B Radiat Oncol. 2024; 19(1):115.

PMID: 39210454 PMC: 11363400. DOI: 10.1186/s13014-024-02512-8.

References

Stranzl H, Zurl B, Langsenlehner T, Kapp K . Wide tangential fields including the internal mammary lymph nodes in patients with left-sided breast cancer. Influence of respiratory-controlled radiotherapy (4D-CT) on cardiac exposure. Strahlenther Onkol. 2009; 185(3):155-60. DOI: 10.1007/s00066-009-1939-2. View

McIntosh A, Shoushtari A, Benedict S, Read P, Wijesooriya K . Quantifying the reproducibility of heart position during treatment and corresponding delivered heart dose in voluntary deep inhalation breath hold for left breast cancer patients treated with external beam radiotherapy. Int J Radiat Oncol Biol Phys. 2011; 81(4):e569-76. DOI: 10.1016/j.ijrobp.2011.01.044. View

Schonecker S, Walter F, Freislederer P, Marisch C, Scheithauer H, Harbeck N . Treatment planning and evaluation of gated radiotherapy in left-sided breast cancer patients using the Catalyst/Sentinel system for deep inspiration breath-hold (DIBH). Radiat Oncol. 2016; 11(1):143. PMC: 5080745. DOI: 10.1186/s13014-016-0716-5. View

Jensen C, Abramova T, Frengen J, Lund J . Monitoring deep inspiration breath hold for left-sided localized breast cancer radiotherapy with an in-house developed laser distance meter system. J Appl Clin Med Phys. 2017; 18(5):117-123. PMC: 5875834. DOI: 10.1002/acm2.12137. View

Dolezel M, Odrazka K, Vanasek J . Deep-inspiration breath hold radiotherapy in patients with left-sided breast cancer after partial mastectomy. Rozhl Chir. 2021; 100(4):180-185. DOI: 10.33699/PIS.2021.100.4.. View

Taylor C, Nisbet A, McGale P, Goldman U, Darby S, Hall P . Cardiac doses from Swedish breast cancer radiotherapy since the 1950s. Radiother Oncol. 2008; 90(1):127-35. DOI: 10.1016/j.radonc.2008.09.029. View

Rutqvist L, Lax I, Fornander T, Johansson H . Cardiovascular mortality in a randomized trial of adjuvant radiation therapy versus surgery alone in primary breast cancer. Int J Radiat Oncol Biol Phys. 1992; 22(5):887-96. DOI: 10.1016/0360-3016(92)90784-f. View

Shah C, Badiyan S, Berry S, Khan A, Goyal S, Schulte K . Cardiac dose sparing and avoidance techniques in breast cancer radiotherapy. Radiother Oncol. 2014; 112(1):9-16. DOI: 10.1016/j.radonc.2014.04.009. View

Darby S, Ewertz M, McGale P, Bennet A, Blom-Goldman U, Bronnum D . Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med. 2013; 368(11):987-98. DOI: 10.1056/NEJMoa1209825. View

10.

Hepp R, Ammerpohl M, Morgenstern C, Nielinger L, Erichsen P, Abdallah A . Deep inspiration breath-hold (DIBH) radiotherapy in left-sided breast cancer: Dosimetrical comparison and clinical feasibility in 20 patients. Strahlenther Onkol. 2015; 191(9):710-6. DOI: 10.1007/s00066-015-0838-y. View

11.

Mantel N, Haenszel W . Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst. 1959; 22(4):719-48. View

12.

DerSimonian R, Laird N . Meta-analysis in clinical trials. Control Clin Trials. 1986; 7(3):177-88. DOI: 10.1016/0197-2456(86)90046-2. View

13.

Goyal U, Saboda K, Roe D, Gonzalez V . Prone Positioning With Deep Inspiration Breath Hold for Left Breast Radiotherapy. Clin Breast Cancer. 2020; 21(4):e295-e301. DOI: 10.1016/j.clbc.2020.11.004. View

14.

Dincoglan F, Beyzadeoglu M, Sager O, Oysul K, Kahya Y, Gamsiz H . Dosimetric evaluation of critical organs at risk in mastectomized left-sided breast cancer radiotherapy using breath-hold technique. Tumori. 2013; 99(1):76-82. DOI: 10.1177/030089161309900113. View

15.

Shim J, Kim J, Park W, Seo J, Hong C, Song K . Dose-Volume Analysis of Lung and Heart according to Respiration in Breast Cancer Patients Treated with Breast Conserving Surgery. J Breast Cancer. 2012; 15(1):105-10. PMC: 3318161. DOI: 10.4048/jbc.2012.15.1.105. View

16.

Ferini G, Molino L, Tripoli A, Valenti V, Illari S, Marchese V . Anatomical Predictors of Dosimetric Advantages for Deep-inspiration-breath-hold 3D-conformal Radiotherapy Among Women With Left Breast Cancer. Anticancer Res. 2021; 41(3):1529-1538. DOI: 10.21873/anticanres.14912. View

17.

Simonetto C, Eidemuller M, Gaasch A, Pazos M, Schonecker S, Reitz D . Does deep inspiration breath-hold prolong life? Individual risk estimates of ischaemic heart disease after breast cancer radiotherapy. Radiother Oncol. 2018; 131:202-207. DOI: 10.1016/j.radonc.2018.07.024. View

18.

Singh Saini A, Das I, Hwang C, Biagioli M, Lee 3rd W . Biological Indices Evaluation of Various Treatment Techniques for Left-Sided Breast Treatment. Pract Radiat Oncol. 2019; 9(6):e579-e590. DOI: 10.1016/j.prro.2019.06.020. View

19.

Al-Hammadi N, Caparrotti P, Naim C, Hayes J, Rebecca Benson K, Vasic A . Voluntary Deep Inspiration Breath-hold Reduces the Heart Dose Without Compromising the Target Volume Coverage During Radiotherapy for Left-sided Breast Cancer. Radiol Oncol. 2018; 52(1):112-120. PMC: 5839089. DOI: 10.1515/raon-2018-0008. View

20.

Cox J, Stetz J, Pajak T . Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys. 1995; 31(5):1341-6. DOI: 10.1016/0360-3016(95)00060-C. View