Skip to main content

Advertisement

SpringerLink
Log in

Meta-analysis of deep inspiration breath hold (DIBH) versus free breathing (FB) in postoperative radiotherapy for left-side breast cancer

  • Original Article
  • Published:
Breast Cancer Aims and scope Submit manuscript

Abstract

Objectives

This meta-analysis evaluates the difference in deep inspiration breath hold (DIBH) versus free breathing (FB) for patients receiving postoperative radiotherapy for left breast cancer and provides a useful reference for clinical practice.

Methods

The relevant controlled trials of DIBH versus FB in postoperative radiotherapy for left-side breast cancer were retrieved from the databases of PubMed, Science Direct, Cochrane Library, and Web of Science databases. The principal outcome of interest was heart dose, left anterior descending coronary artery (LADCA) dose, and left lung dose and target coverage. We calculated summary standardized mean difference (SMD) and 95% confidence intervals (CI). The meta-analysis was performed using RevMan 5.3 software.

Results

The analysis included 1019 patients from 12 observational studies, of which 576 cases were in the DIBH group and 443 cases in the FB group. Compared with the FB group, the DIBH group can have lower heart dose, left anterior descending coronary artery (LADCA) dose, and left lung dose more effectively, and the difference was statistically significant (heart dose, SMD = − 1.36, 95% CI − 1.64 ~ − 1.09, P < 0.01. LADCA dose, SMD = − 1.45, 95% CI − 1.62 ~ − 1.27, P < 0.01. Left lung dose, SMD = − 0.52, 95% CI − 0.81 ~ − 0.23, P < 0.01). There was no significant difference in target coverage between the two groups (SMD = 0.03, 95% CI − 0.11 ~ 0.18, P = 0.64).

Conclusion

By this meta-analysis, we found that implementation of DIBH in postoperative radiotherapy for left-side breast cancer can reduce irradiation of heart dose, LADCA dose and left lung dose, without compromising target coverage.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Availability of data and material

The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin. 2016;67(1):277–300.

    Google Scholar 

  2. Mcgale P, Taylor C, Correa C, et al. Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet. 2014;383(9935):2127–35.

    Article  CAS  PubMed  Google Scholar 

  3. Beadle BM, Woodward WA, Tucker SL, et al. Ten-year recurrence rates in young women with breast cancer by locoregional treatment approach. Int J Radiat Oncol Biol Phys. 2008;73(3):734–44.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Cho BCJ, Schwarz M, Mijnheer BJ, et al. Simplified intensity-modulated radiotherapy using pre-defined segments to reduce cardiac complications in left-sided breast cancer. Radiother Oncol. 2004;70(3):231–41.

    Article  PubMed  Google Scholar 

  5. Senkus-Konefka E, Jassem J. Cardiovascular effects of breast cancer radiotherapy. Cancer Treat Rev. 2007;33(6):578–93.

    Article  PubMed  Google Scholar 

  6. Darby SC, Ewertz M, Mcgale P, et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med. 2013;368(11):987–98.

    Article  CAS  PubMed  Google Scholar 

  7. Darby SC, Mcgale P, Taylor CW, et al. Long-term mortality from heart disease and lung cancer after radiotherapy for early breast cancer: prospective cohort study of about 300 000 women in US SEER cancer registries. Lancet Oncol. 2005;6(8):557–65.

    Article  PubMed  Google Scholar 

  8. Demirci S, Nam J, Hubbs JL, et al. Radiation-induced cardiac toxicity after therapy for breast cancer: interaction between treatment era and follow-up duration. Int J Radiat Oncol Biol Phys. 2009;73(4):980–7.

    Article  PubMed  Google Scholar 

  9. Henson KE, Mcgale P, Taylor C, et al. Radiation-related mortality from heart disease and lung cancer more than 20 years after radiotherapy for breast cancer. Br J Cancer. 2013;108(1):179–82.

    Article  CAS  PubMed  Google Scholar 

  10. Alderliesten T, Betgen A, Elkhuizen PHM, et al. Estimation of heart-position variability in 3D-surface-image-guided deep-inspiration breath-hold radiation therapy for left-sided breast cancer. Radiother Oncol. 2013;109(3):442–7.

    Article  PubMed  Google Scholar 

  11. Sixel KE, Aznar MC, Ung YC. Deep inspiration breath hold to reduce irradiated heart volume in breast cancer patients. Int J Radiat Oncol Biol Phys. 2001;49(1):199–204.

    Article  CAS  PubMed  Google Scholar 

  12. Pedersen AN, Korreman S, Nyström H, et al. Breathing adapted radiotherapy of breast cancer: reduction of cardiac and pulmonary doses using voluntary inspiration breath-hold. Radiother Oncol. 2004;72(1):53–60.

    Article  PubMed  Google Scholar 

  13. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25(9):603–5.

    Article  PubMed  Google Scholar 

  14. Shuster JJ. Review: Cochrane handbook for systematic reviews for interventions, Version 5.1.0, published 3/2011. Julian P.T. Higgins and Sally Green, Editors. Res Synth Methods. 2011;2(2):126–30.

    Article  Google Scholar 

  15. Feng Z, Jiayan S, Zhongjie L, et al. Abdominal DIBH reduces the cardiac dose even further: a prospective analysis. Radiother Oncol. 2018;13(1):116.

    Google Scholar 

  16. Lawler G, Leech M. Dose sparing potential of deep inspiration breath-hold technique for left breast cancer radiotherapy organs-at-risk. Anticancer Res. 2017;37(2):883–90.

    Article  PubMed  Google Scholar 

  17. Kunheri B, Kotne S, Nair SS, et al. A dosimetric analysis of cardiac dose with or without active breath coordinator moderate deep inspiratory breath hold in left sided breast cancer radiotherapy. J Cancer Res Ther. 2017;13(1):56–61.

    Article  PubMed  Google Scholar 

  18. Mohamad O, Shiao J, Zhao B, Roach K, Ramirez E, Vo DT, et al. Deep inspiration breathhold for left-sided breast cancer patients with unfavorable cardiac anatomy requiring internal mammary nodal irradiation. Pract Radiat Oncol. 2017;7(6):e361–7.

    Article  PubMed  Google Scholar 

  19. Jensen CA, Abramova T, Frengen J, et al. 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):117–23.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Eldredge-Hindy H, Lockamy V, Crawford A, Nettleton V, Werner-Wasik M, Siglin J, et al. Active Breathing Coordinator reduces radiation dose to the control in patients with left breast cancer: report of a prospective heart and preserves local trial. Pract Radiat Oncol. 2015;5(1):4–10.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Rochet N, Drake JI, Harrington K, et al. Deep inspiration breath-hold technique in left-sided breast cancer radiation therapy: evaluating cardiac contact distance as a predictor of cardiac exposure for patient selection. Pract Radiat Oncol. 2015;5(3):e127–34.

    Article  PubMed  Google Scholar 

  22. Tanguturi SK, Lyatskaya Y, Chen Y, Catalano PJ, Chen MH, Yeo WP, et al. Prospective assessment of deep inspiration breath-hold using 3-dimensional surface tracking for irradiation of left-sided breast cancer. Pract Radiat Oncol. 2015;5(6):358–65.

    Article  PubMed  Google Scholar 

  23. Wiant D, Wentworth S, Liu H, Sintay B. How important is a reproducible breath hold for deep inspiration breath hold breast radiation therapy. Int J Radiat Oncol Biol Phys. 2015;93(4):901–7.

    Article  PubMed  Google Scholar 

  24. Comsa D, Barnett E, Le K, Mohamoud G, Zaremski D, Fenkell L, et al. Introduction of moderate deep inspiration breath hold for radiation therapy of left breast: initial experience of a regional cancer center. Pract Radiat Oncol. 2014;4(5):298–305.

    Article  PubMed  Google Scholar 

  25. Nissen HD, Appelt AL. Improved heart, lung and target dose with deep inspiration breath hold in a large clinical series of breast cancer patients. Radiother Oncol. 2013;106(1):28–32.

    Article  PubMed  Google Scholar 

  26. Vikström J, Hjelstuen MHB, Mjaaland I, et al. Cardiac and pulmonary dose reduction for tangentially irradiated breast cancer, utilizing deep inspiration breath-hold with audio-visual guidance, without compromising target coverage. Acta Oncol. 2011;50(1):42–50.

    Article  PubMed  Google Scholar 

  27. Darby S, McGale P, Correa C, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet. 2011;378(9804):1707–16.

    Article  CAS  PubMed  Google Scholar 

  28. Clarke M, Collins R, Darby S, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;366(9503):2087–106.

    Article  CAS  PubMed  Google Scholar 

  29. Taylor CW, Nisbet A, Mcgale P, et al. Cardiac doses from Swedish breast cancer radiotherapy since the 1950s. Radiother Oncol. 2009;90(1):127–35.

    Article  PubMed  Google Scholar 

  30. Jagsi R, Griffith KA, Koelling T, et al. Rates of myocardial infarction and coronary artery disease and risk factors in patients treated with radiation therapy for early-stage breast cancer. Cancer. 2007;109(4):650–7.

    Article  PubMed  Google Scholar 

  31. Correa CR, Litt HI, Hwang WT, et al. Coronary artery findings after left-sided compared with right-sided radiation treatment for early-stage breast cancer. J Clin Oncol. 2007;25(21):3031–7.

    Article  PubMed  Google Scholar 

  32. Darby SC, Cutter DJ, Boerma M, et al. Radiation-related heart disease: current knowledge and future prospects. Int J Radiat Oncol Biol Phys. 2010;76(3):656–65.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Mulliez T, Veldeman L, Speleers B, et al. Heart dose reduction by prone deep inspiration breath hold in left-sided breast irradiation. Radiother Oncol. 2015;114(1):79–84.

    Article  PubMed  Google Scholar 

  34. Cox JD, Stetz JA, Pajak TF. 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.

    Article  CAS  PubMed  Google Scholar 

  35. Goldman UB, Wennberg B, Svane G, et al. Reduction of radiation pneumonitis by V20-constraints in breast cancer. Radiat Oncol. 2010;5(1):99.

    Article  PubMed Central  Google Scholar 

  36. Blom Goldman U, Anderson M, Wennberg B, et al. Radiation pneumonitis and pulmonary function with lung dose–volume constraints in breast cancer irradiation. J Radiother Pract. 2014;13(02):211–7.

    Article  CAS  PubMed  Google Scholar 

  37. Palma DA, Senan S, Tsujino K, et al. Predicting radiation pneumonitis after chemoradiation therapy for lung cancer: an international individual patient data meta-analysis. Int J Radiat Oncol Biol Phys. 2013;85(2):444–50.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank Senxiang Yan (PhD, Radiotherapy Center, the First Affiliated Hospital of Zhejiang University) for providing assistance and contributing to revisions.

Funding

This study was supported by grants from The First batch of Yiwu Science and Technology Project in 2019 [Grant Number: 19-3-03].

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Yiwu Central Hospital, The Affiliated Yiwu Hospital of Wenzhou Medical University, Yiwu, 322000, Zhejiang, People’s Republic of China

    Junming Lai, Yongbiao Luo, Rikui Zheng, Qibao Zhu, Pingliang Chen & Beiyuan Chi

  2. Department of General Medicine, Yiwu Central Hospital, The Affiliated Yiwu Hospital of Wenzhou Medical University, Yiwu, 322000, Zhejiang, People’s Republic of China

    Shuang Hu

  3. Department of Pediatrics, Yiwu Central Hospital, The Affiliated Yiwu Hospital of Wenzhou Medical University, Yiwu, 322000, Zhejiang, People’s Republic of China

    Yunhui Zhang

  4. Department of Medicine of the Graduate School, Nanchang University, Nanchang, 330006, Jiangxi, People’s Republic of China

    Fangyan Zhong

  5. Department of Medicine of the Graduate School, Wuhan University, Wuhan, 430000, Hubei, People’s Republic of China

    Xin Long

Authors
  1. Junming Lai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shuang Hu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yongbiao Luo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rikui Zheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Qibao Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Pingliang Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Beiyuan Chi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yunhui Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Fangyan Zhong
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Xin Long
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

JL performed the planning study and the statistical analysis and drafted the manuscript. SH, YL, RZ, QZ, and PC participated in information and data collection. MZ, YZ, and FZ helped to draft the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Junming Lai.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lai, J., Hu, S., Luo, Y. et al. Meta-analysis of deep inspiration breath hold (DIBH) versus free breathing (FB) in postoperative radiotherapy for left-side breast cancer. Breast Cancer 27, 299–307 (2020). https://doi.org/10.1007/s12282-019-01023-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12282-019-01023-9

Keywords

Search

Navigation