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Hepatocellular Carcinoma Treatment and Prognosis / Breast Cancer Treatment Studies / Chemotherapy-induced Cardiotoxicity and Mitigation · Journal article
Precision Radiation Oncology · August 12, 2026
Encouraging direction, but not yet definitive.
This paired dosimetric study demonstrates that DIBH significantly reduces mean heart dose by 22% and mean left lung dose by 7–10% compared to free breathing in left-sided breast cancer radiotherapy, with NTCP modelling predicting reductions in cardiopulmonary complication rates. However, predicted reductions are based on mathematical models, not clinical follow-up, limiting direct evidence of benefit.
Prospective paired dosimetric comparison study. 40 patients with left-sided breast cancer undergoing postoperative adjuvant radiotherapy; 20 conventional, 20 hypofractionated.. Intervention: Deep inspiration breath hold (DIBH) during radiotherapy planning and treatment. Compared with: Free breathing (FB) during radiotherapy planning. n = 40.
DIBH reduced MHD by 22% in conventional radiotherapy (P = 0.004, 95% CI [14, 31]) and by 22% in hypofractionated radiotherapy (P = 0.003, 95% CI [14, 30]) DIBH reduced mean left lung dose by 10% in conventional radiotherapy (P = 0.010, 95% CI [2, 15]) and by 7% in hypofractionated radiotherapy (P = 0.008, 95% CI [0, 14]) NTCP modelling predicted DIBH reduced pericarditis/pericardial effusion risk by 35–39%, RVD by 46–51%, CAD by 4–7%, and RTOG grade ≥2 RP by 4–6%
No clinical follow-up data; all toxicity predictions are from NTCP models, not observed events
Clinicians considering DIBH for left-sided breast cancer radiotherapy should note that dosimetric benefit is clear and consistent, but actual clinical cardiopulmonary outcomes remain unproven. Long-term clinical follow-up studies are needed to validate the predicted toxicity reductions.
A well-designed comparative dosimetric study with NTCP modelling showing consistent reductions in predicted cardiopulmonary toxicity across two treatment regimens, but based on surrogate endpoints (dose and modelled complications) rather than clinical outcomes.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians considering DIBH for left-sided breast cancer radiotherapy should note that dosimetric benefit is clear and consistent, but actual clinical cardiopulmonary outcomes remain unproven. Long-term clinical follow-up studies are needed to validate the predicted toxicity reductions.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Abstract Background and purpose Deep inspiration breath hold (DIBH) is a respiratory control technique designed to minimize cardiopulmonary toxicity induced by adjuvant radiotherapy for left‐sided breast cancer. This study aimed to evaluate the dosimetric effects of DIBH compared with those of free breathing (FB) in patients undergoing postoperative radiotherapy for left‐sided breast cancer in order to assess differences in potential cardiopulmonary complications between the two approaches. Methods Forty patients with left‐sided breast cancer undergoing postoperative adjuvant radiotherapy were included. Of these, 20 patients received conventional radiotherapy (5000 cGy in 25 fractions), and the other 20 patients received hypofractionated radiotherapy (4005 cGy in 15 fractions, with a sequential boost to the tumor bed of 1000 cGy in 5 fractions). Treatment plans were performed on both FB and DIBH computed tomography images for each patient. Mean heart dose (MHD), mean left lung dose, and other cardiopulmonary parameters were recorded. The normal tissue complication probability (NTCP) model was applied to predict complications, including pericarditis/pericardial effusion, heart valvular dysfunction (RVD), coronary artery disease (CAD), and Radiation Therapy Oncology Group (RTOG) grade ≥ 2 radiation pneumonitis (RP). Clinical anatomical features, including the number of contact layers between the heart surface and the chest wall (defined as Contact_Heart) and the Haller index (HI), were also documented, followed by correlation analysis. Results The DIBH technique significantly reduced MHD by 22% in both conventional radiotherapy ( P = 0.004, 95% confidence interval [CI][14, 31]) and hypofractionated radiotherapy ( P = 0.003, 95% CI[14, 30]). DIBH also reduced the mean left lung dose by 10% in conventional radiotherapy ( P = 0.010, 95% CI[2, 15]) and by 7% in hypofractionated radiotherapy ( P = 0.008, 95% CI[0, 14]). Using the NTCP model to predict the risk of toxicities, DIBH reduced the predicted occurrence rates of pericarditis/pericardial effusion, RVD, CAD, and RTOG grade ≥ 2 RP by 35–39%, 46–51%, 4–7%, and 4–6%, respectively, across both treatment modalities. Contact_Heart was positively correlated with MHD but only weakly correlated with HI. Conclusion DIBH significantly reduces radiation exposure to the heart and lungs in patients with left‐sided breast cancer undergoing radiotherapy, potentially decreasing the risk of cardiopulmonary toxicity.
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