PeerJ · 2026
Dosimetric impact of deep inspiration breath hold (DIBH) technique in right-sided breast cancer radiotherapy: a retrospective analysis.
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Yazici Yusuf, Tambiah Jeyanesh R S, Swearingen Christopher J, Lopez Victor A, Kennedy Sarah, Fineman Mark S, Simsek Ismail, Solomon Emily, Mcalindon Timothy E
Аннотация
BACKGROUND AND PURPOSE: While deep-inspiration breath hold (DIBH) is widely used to reduce cardiac dose in left-sided breast cancer radiotherapy, its dosimetric benefits for right-sided cases remain underexplored. This study evaluated DIBH's impact on target coverage and organs at risk (OARs) in right-sided breast cancer, and investigated associations between dose-volume changes, lung volume, and anthropometric indices.
METHODS: We retrospectively analyzed 33 patients with right-sided breast cancer treated using DIBH. Seventeen patients received whole-breast (WB) irradiation following post-breast-conserving surgery, and sixteen received chest wall (CW) plus internal mammary node (IMN) and supraclavicular (SC) irradiation post-mastectomy. Computed tomography (CT) scans acquired under free breathing (FB) and DIBH were used to generate separate treatment plans. Dose-volume parameters for target volumes and OARs were compared, and correlations between FB-to-DIBH changes and body mass index (BMI) and body surface area (BSA) were analyzed.
RESULTS: Compared with FB, DIBH significantly reduced doses to the right lung, heart, right coronary artery (RCA), and liver in both cohorts (all P < 0.05), while planning target volume (PTV) coverage remained unchanged. The maximum dose to the contralateral breast (Dmax) also decreased under DIBH, with reductions of 22.7% in the WB group (P = 0.02) and 37.76% in the CW+IMN+SC group (P < 0.001). Body mass index (BMI) showed a significant association with DIBH induced liver dose reduction in the WB cohort (liver mean dose, Dmean: r = 0.622, P = 0.008; liver volume receiving > =5Gy, V5Gy: r = 0.483, P = 0.05). In contrast, no meaningful correlations with dosimetric parameters were observed for BSA (all P > 0.05).
CONCLUSION: DIBH effectively reduced OAR doses in right-sided breast cancer radiotherapy while maintaining target coverage. Patients with higher BMI derived greater hepatic dose sparing, suggesting that BMI-informed patient selection may enhance the clinical utility of DIBH.
METHODS: We retrospectively analyzed 33 patients with right-sided breast cancer treated using DIBH. Seventeen patients received whole-breast (WB) irradiation following post-breast-conserving surgery, and sixteen received chest wall (CW) plus internal mammary node (IMN) and supraclavicular (SC) irradiation post-mastectomy. Computed tomography (CT) scans acquired under free breathing (FB) and DIBH were used to generate separate treatment plans. Dose-volume parameters for target volumes and OARs were compared, and correlations between FB-to-DIBH changes and body mass index (BMI) and body surface area (BSA) were analyzed.
RESULTS: Compared with FB, DIBH significantly reduced doses to the right lung, heart, right coronary artery (RCA), and liver in both cohorts (all P < 0.05), while planning target volume (PTV) coverage remained unchanged. The maximum dose to the contralateral breast (Dmax) also decreased under DIBH, with reductions of 22.7% in the WB group (P = 0.02) and 37.76% in the CW+IMN+SC group (P < 0.001). Body mass index (BMI) showed a significant association with DIBH induced liver dose reduction in the WB cohort (liver mean dose, Dmean: r = 0.622, P = 0.008; liver volume receiving > =5Gy, V5Gy: r = 0.483, P = 0.05). In contrast, no meaningful correlations with dosimetric parameters were observed for BSA (all P > 0.05).
CONCLUSION: DIBH effectively reduced OAR doses in right-sided breast cancer radiotherapy while maintaining target coverage. Patients with higher BMI derived greater hepatic dose sparing, suggesting that BMI-informed patient selection may enhance the clinical utility of DIBH.