Table 1.
Reduction of mean LAD and heart doses in studies examining free breathing versus DIBH techniques for breast cancer radiation treatment.
| Study | DIBH method | # Patients | Area(s) treated | Mean LAD dose (Gy) |
Mean heart dose (Gy) |
||||
|---|---|---|---|---|---|---|---|---|---|
| FB | DIBH | Reduction | FB | DIBH | Reduction | ||||
| Stranzl and Zurl (33) | voluntary DIBH (vDIBH) (RPM) | 22 | Breast/CW ± boost | – | – | – | 2.3 | 1.3 | 44% |
| Stranzl et al. (34) | vDIBH (RPM) | 11 | Breast/CW + IMC LN | – | – | – | 4.0 | 2.5 | 38% |
| Borst et al. (35) | vDIBH (other) | 19 | Breast/CW ± boost | 11.4 | 5.5 | 52% | 5.1 | 1.7 | 67% |
| Johansen et al. (36) | vDIBH (RPM) | 16 | Breast | – | – | – | 6.5 | 2.5 | 62% |
| McIntosh et al. (37) | vDIBH (RPM) | 10 | Breast | Not reported | Not reported | 43% | Not reported | Not reported | 48% |
| Vikstrom et al. (38) | vDIBH (RPM) | 17 | Breast | 18.1 | 6.4 | 65% | 3.7 | 1.7 | 54% |
| Hayden et al. (39) | vDIBH (RPM) | 30 | Breast + boost | 33.7 | 21.9 | 35%e | 6.9 | 4.0 | 42% |
| Hjelstuen et al. (40) | vDIBH (RPM) | 17 | Breast + SCV + Ax + IMC LN | 25.0 | 10.9 | 56% | 6.2 | 3.1 | 50% |
| Wang et al. (41) | ABC | 20 | Breast | 20.0 | 5.9 | 71% | 3.2 | 1.3 | 59% |
| Bruzzaniti et al. (42) | vDIBH (RPM) | 8 | Breast | 9.0 | 2.7 | 70% | 1.7 | 1.2 | 29% |
| Lee et al. (43) | vDIBH (RPM) | 25 | Breast | 26.3 | 16.0 | 39% | 4.5 | 2.5 | 44% |
| Mast et al. (44) | ABC | 20 | Breast | 18.614.9 | 9.66.7 | 48%a55%b | 3.32.7 | 1.81.5 | 45%a44%b |
| Nissen and Appelt (45) | ABC | 227c | Breast/CW ± SCV + Ax LN | – | – | – | 5.2 | 2.7 | 48% |
| Reardon et al. (46) | vDIBH (RPM) | 10 | Breast | 2.5 | 1.8 | 29%f | 1.6 | 0.9 | 45%f |
| Swanson et al. (47) | ABC | 87 | Breast/CW ± SCV + Ax LN | – | – | – | 4.2 | 2.5 | 40% |
| Bolukbasi et al. (48) | vDIBH (RPM) | 1010 | Breast | 1.75.0 | 0.84.0 | 53%g20%h | 1.74.9 | 0.73.7 | 59%g25%h |
| Comsa et al. (49) | ABC | 2030 | Breast ± boostBreast/CW + SCV + Ax LN | –– | –– | –– | 3.14.5 | 1.22.1 | 61%53% |
| Osman et al. (50) | vDIBH (RPM) | 13 | Breast + SCV + Ax + IMC LN | –– | –– | –– | 9.05.8 | 5.04.1 | 44%a29%b |
| Verhoeven et al. (27) | vDIBH (RPM) | 17 | Breast | 30.9 | 22.4 | 28% | 3.5 | 1.6 | 54% |
| Eldredge-Hindy et al. (51) | ABC | 86 | Breast ± boost ± SCV + Ax ± IMC LN | – | – | – | 2.7 | 0.9 | 67%d |
| Joo et al. (52) | vDIBH (RPM) | 32 | Breast/CW ± SCV + Ax | 40.8 | 23.7 | 42% | 7.2 | 2.8 | 61% |
| Mulliez et al. (28) | vDIBH (RPM) | 12 | Breast | 17.6 | 10.9 | 38% | 4.0 | 2.2 | 45% |
| Rochet et al. (53) | vDIBH (other) | 35 | Breast/CW ± SCV + Ax + IMC LN | 14.9 | 4.0 | 73% | 2.5 | 0.9 | 64% |
| Tanguturi et al. (54) | vDIBH (AlignRT) | 146 | Breast/CW ± SCV + Ax ± IMC LN | – | – | – | 2.6 | 1.4 | 46% |
| Wiant et al. (55) | vDIBH (other) | 25 | Breast | – | – | – | 3.0 | 1.4 | 53% |
| Yeung et al. (56) | vDIBH (other) | 20 | Breast/CW ± SCV + Ax + IMC LN | 13.6 | 4.1 | 70% | 2.6 | 1.3 | 50% |
| Walston et al. (57) | vDIBH (AlignRT) | 78 | Breast ± boostCW ± boost ± SCV + Ax + IMC LN | –– | –– | –– | 1.35.1 | 0.93.6 | 31%29% |
| Lawler and Leech (58) | RPM | 28 | Breast/CW ± SCV | 10.9 | 5.2 | 52% | 1.8 | 1.2 | 33% |
| Kunheri et al. (59) | ABC | 45 | Breast | 13.2 | 6.1 | 54% | 3.1 | 1.6 | 52% |
| Mohamad et al. (60) | ABC | 22 | Breast/CW + SCV + Ax + IMC LN | 21.3 | 9.4 | 56% | 5.8 | 2.2 | 62% |
ABC, active breathing coordinator; Ax, axillary; CW, chest wall; DIBH, deep inspiration breath hold; Gy (gray); FB, free breathing; IMC, internal mammary chain; LAD, left anterior descending coronary artery; LN, lymph nodes; RPM, real-time positioning management system; SCV, supraclavicular; IMRT, Intensity modulated radiation therapy.
a3D conformal radiation therapy.
bIMRT/VMAT.
c227 left-sided (144 received DIBH; 83 received FB treatment).
dMedian values for mean doses.
eLAD planning organ at risk volume (PRV).
fFB-IMRT versus 3D-DIBH.
gFB versus DIBH forward-planned IMRT.
hFB versus DIBH inverse-planned IMRT.