Cardiac dose comparison of abdominal and thoracic deep inspiration breath hold in adult female with left-sided breast cancer receiving radiation therapy: A systematic review and meta-analysis

Introduction: 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.

Methods: 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 I² statistic.

Results: 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).

Conclusion: 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.

Implication for practice: 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.