The cardiac dose‐sparing benefits of deep inspiration breath‐hold in left breast irradiation: a systematic review

Abstract

IntroductionDespite technical advancements in breast radiation therapy, cardiac structures are still subject to significant levels of irradiation. As the use of adjuvant radiation therapy after breast-conserving surgery continues to improve survival for early breast cancer patients, the associated radiation-induced cardiac toxicities become increasingly relevant. Our primary aim was to evaluate the cardiac-sparing benefits of the deep inspiration breath-hold (DIBH) technique.MethodsAn electronic literature search of the PubMed database from 1966 to July 2014 was used to identify articles published in English relating to the dosimetric benefits of DIBH. Studies comparing the mean heart dose of DIBH and free breathing treatment plans for left breast cancer patients were eligible to be included in the review. Studies evaluating the reproducibility and stability of the DIBH technique were also reviewed.ResultsTen studies provided data on the benefits of DIBH during left breast irradiation. From these studies, DIBH reduced the mean heart dose by up to 3.4 Gy when compared to a free breathing approach. Four studies reported that the DIBH technique was stable and reproducible on a daily basis. According to current estimates of the excess cardiac toxicity associated with radiation therapy, a 3.4 Gy reduction in mean heart dose is equivalent to a 13.6% reduction in the projected increase in risk of heart disease.ConclusionDIBH is a reproducible and stable technique for left breast irradiation showing significant promise in reducing the late cardiac toxicities associated with radiation therapy.

Monitoring deep inspiration breath hold for left‐sided localized breast cancer radiotherapy with an in‐house developed laser distance meter system

“…only found four studies, with a total of 69 subjects, that have reported on reproducibility or stability of DIBH treatment 31. Three of the studies used breast surface, and one heart position, to estimate the reproducibility and stability.…”

Planning strategies and practical implementation of the cardiac dose reduction in the left-side breast irradiation with the deep inspiration breath-hold (DIBH) method

“…The majority of the so far puplicated planning studies on the use of DIBH and the reduction of cardiac dose, only contain a comparison of 3D and IMRT treatment techniques [1,2,3,4]. Also, only the evaluation of the mean dose exposure is taken into account for late effects and radioinduced heart diseases.…”

General Overview and Treatment Recommendations for Young Women with Breast Cancer

“…Tangential three-dimensional conformal or intensity modulated radiotherapy planning approaches allow for more homogenous target coverage, and at the same time, dose-volume estimations of delivered dose to organs at risk. Different strategies to reduce the dose to thoracic organs are being researched [108][109][110] . Image-guided deep inspiratory breath hold is a reproducible and stable radiotherapy technique, which can be implemented as a voluntary, non-computer-controlled technique in breast/chest wall and/or locoregional radiotherapy, including its use in low-resource settings 111 .…”

“…Image-guided deep inspiratory breath hold is a reproducible and stable radiotherapy technique, which can be implemented as a voluntary, non-computer-controlled technique in breast/chest wall and/or locoregional radiotherapy, including its use in low-resource settings 111 . Deep inspiratory breath hold has been shown to significantly reduce dose to heart, left anterior descending coronary artery, and lung 108,112 .…”