Pang W Y C, Yu K S, Loke A Y
Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong.
St Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, England, United Kingdom.
Radiography (Lond). 2025 Jan;31(1):426-433. doi: 10.1016/j.radi.2024.12.013. Epub 2025 Jan 7.
Deep inspiration breath hold technique has shown promise in reducing cardiac toxicity and improving patient outcomes. However, there is a lack of consensus regarding the implementation of abdominal breath hold technique and its impact on cardiac dose. This systematic review and meta-analysis aim to provide insights into the comparative effectiveness of abdominal and thoracic breath hold in mitigating cardiac toxicity during radiation therapy for left-sided breast cancer.
A comprehensive literature search was conducted in electronic databases (PubMed, Medline, Science Direct) to identify relevant studies. Dosimetric comparison studies between abdominal and thoracic breath hold conducted on adult female patients with primary left-sided breast cancer undergoing DIBH radiation therapy were included. Random effects meta-analyses were performed to estimate pooled effect sizes, and heterogeneity was evaluated using I statistic.
A total of four studies, encompassing 166 patients, were included in the review. Meta-analysis revealed a statistically significant reduction in the mean dose to the left anterior descending artery with abdominal breath hold compared to thoracic breath hold (2.03Gy, 95%CI 0.58-3.47). No significant difference was observed in mean heart dose between the two techniques (0Gy, 95%CI -0.28-0.27).
Variations in patient coaching and radiation therapy planning practices may impact the achieved cardiac dose reduction. Further studies are warranted to evaluate long-term clinical outcomes associated with different DIBH techniques and optimize treatment planning strategies in left-sided breast radiation therapy.
Results of the study suggested that implementation of abdominal DIBH may reduce the potential risk of radiation-related cardiac complications. By establishing consistent standards for coaching techniques, radiation therapists can promote uniformity in training and improve the accuracy and reproducibility of breath hold treatments.
深吸气屏气技术在降低心脏毒性和改善患者预后方面已显示出前景。然而，关于腹部屏气技术的实施及其对心脏剂量的影响，目前尚无共识。本系统评价和荟萃分析旨在深入了解腹部屏气和胸部屏气在减轻左侧乳腺癌放射治疗期间心脏毒性方面的相对有效性。
在电子数据库（PubMed、Medline、Science Direct）中进行全面的文献检索，以识别相关研究。纳入对接受深吸气屏气放射治疗的成年原发性左侧乳腺癌女性患者进行腹部屏气和胸部屏气的剂量学比较研究。采用随机效应荟萃分析来估计合并效应量，并使用I统计量评估异质性。
该评价共纳入四项研究，涉及166名患者。荟萃分析显示，与胸部屏气相比，腹部屏气时左前降支动脉的平均剂量有统计学意义的降低（2.03Gy，95%CI 0.58 - 3.47）。两种技术在平均心脏剂量方面未观察到显著差异（0Gy，95%CI -0.28 - 0.27）。
患者指导和放射治疗计划实践的差异可能会影响实现的心脏剂量降低效果。有必要进一步研究评估与不同深吸气屏气技术相关的长期临床结局，并优化左侧乳腺放射治疗的治疗计划策略。
研究结果表明，实施腹部深吸气屏气可能会降低与放射相关的心脏并发症的潜在风险。通过建立一致的指导技术标准，放射治疗师可以促进培训的一致性，并提高屏气治疗的准确性和可重复性。
