nach oben

Erschienen in:

09.11.2019 | Original Article

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

verfasst von: Junming Lai, Shuang Hu, Yongbiao Luo, Rikui Zheng, Qibao Zhu, Pingliang Chen, Beiyuan Chi, Yunhui Zhang, Fangyan Zhong, Xin Long

Erschienen in: Breast Cancer | Ausgabe 2/2020

Einloggen, um Zugang zu erhalten

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.

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

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.PubMedCrossRef

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.PubMedPubMedCentralCrossRef

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.PubMedCrossRef

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

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.PubMedCrossRef

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.PubMedCrossRef

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.PubMedCrossRef

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.PubMedCrossRef

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.PubMedCrossRef

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.PubMedCrossRef

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.PubMedCrossRef

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.PubMedCrossRef

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.CrossRef

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.

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.PubMedCrossRef

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.PubMedCrossRef

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.PubMedCrossRef

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.PubMedPubMedCentralCrossRef

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.PubMedPubMedCentralCrossRef

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.PubMedCrossRef

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.PubMedCrossRef

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.PubMedCrossRef

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.PubMedCrossRef

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.PubMedCrossRef

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.PubMedCrossRef

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.PubMedCrossRef

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.PubMedCrossRef

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.PubMedCrossRef

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.PubMedCrossRef

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.PubMedCrossRef

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.PubMedPubMedCentralCrossRef

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.PubMedCrossRef

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.PubMedCrossRef

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.PubMedCentralCrossRef

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.PubMedCrossRef

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.PubMedCrossRef

Titel: Meta-analysis of deep inspiration breath hold (DIBH) versus free breathing (FB) in postoperative radiotherapy for left-side breast cancer
verfasst von: Junming Lai
Shuang Hu
Yongbiao Luo
Rikui Zheng
Qibao Zhu
Pingliang Chen
Beiyuan Chi
Yunhui Zhang
Fangyan Zhong
Xin Long
Publikationsdatum: 09.11.2019
Verlag: Springer Japan
Erschienen in: Breast Cancer / Ausgabe 2/2020
Print ISSN: 1340-6868
Elektronische ISSN: 1880-4233
DOI: https://doi.org/10.1007/s12282-019-01023-9

Springer Medizin

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