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. 2022 Apr 21:12:845037.
doi: 10.3389/fonc.2022.845037. eCollection 2022.

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

Yongkai Lu  1 , Di Yang  2 , Xiaowei Zhang  3 , Yonggang Teng  4 , Wei Yuan  1 , Yuemei Zhang  1 , Ruixin He  1 , Fengwen Tang  1 , Jie Pang  3 , Bo Han  5 , Ruijuan Chen  3 , Yi Li  1
Affiliations

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

Yongkai Lu et al. Front Oncol. .

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 (D mean, D max, V30, V10, V5), left anterior descending branch (LAD) dose (D mean, D max), ipsilateral lung dose (D mean, 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.

Keywords: deep inspiration breath hold; free breathing; left sided breast cancer; meta-analysis; radiotherapy.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of the search process for the meta-analysis.
Figure 2
Figure 2
Forest plot of heart dose (D mean and Dmax) between the DIBH group and FB group.
Figure 3
Figure 3
Forest plot of heart dose (V30, V10 and V5) between the DIBH group and FB group.
Figure 4
Figure 4
Forest plot of LAD dose (D mean and Dmax) between the DIBH group and FB group.
Figure 5
Figure 5
Forest plot of ipsilateral lung dose (D mean) between the DIBH group and FB group.
Figure 6
Figure 6
Forest plot of ipsilateral lung dose (V20, V10 and V5) between the DIBH group and FB group.
Figure 7
Figure 7
Forest plot of contralateral breast mean dose between the DIBH group and FB group.
Figure 8
Figure 8
Forest plot of heart volume between the DIBH group and FB group.
Figure 9
Figure 9
Forest plot of ipsilateral lung volume between the DIBH group and FB group.
Figure 10
Figure 10
Funnel plots for potential publication bias. Funnel plot analysis of heart dose (A, B), LAD dose (C, D), ipsilateral lung dose (E, F), heart volume (G) and ipsilateral lung volume (H).
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