The cardiac dose-sparing benefits of deep inspiration breath-hold in left breast irradiation: a systematic review.
The cardiac dose-sparing benefits of deep inspiration breath-hold in left breast irradiation: a systematic review.
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DOI：
10.1002/jmrs.89
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发表时间：
2015-03
影响因子：
2.1
通讯作者：
Wasiak, Jason
中科院分区：
文献类型：
--
作者：
Smyth, Lloyd M;Knight, Kellie A;Aarons, Yolanda K;Wasiak, Jason
尽管乳房放射治疗技术进步，心脏结构仍然受到显着水平的辐射。随着保乳手术后辅助放射治疗的使用继续提高早期乳腺癌患者的生存率，相关的放射诱导的心脏毒性变得越来越相关。我们的主要目的是评估深吸气屏气（DIBH）技术的心脏保护益处。对PubMed数据库进行了1966年至2014年7月的电子文献检索，以识别与DIBH剂量学获益相关的英文发表文章。比较左乳腺癌患者DIBH和自由呼吸治疗计划的平均心脏剂量的研究符合纳入审查的条件。对DIBH技术的重现性和稳定性进行了评价。10项研究提供了关于DIBH在左乳房照射期间的益处的数据。根据这些研究，与自由呼吸方法相比，DIBH可将平均心脏剂量降低高达3.4戈伊。4项研究报告称，DIBH技术稳定，且每日可重现。根据目前对与放射治疗相关的过度心脏毒性的估计，平均心脏剂量减少3.4戈伊相当于心脏病风险预计增加减少13.6%。DIBH是一种可重复和稳定的左乳房照射技术，在减少与放射治疗相关的晚期心脏毒性方面显示出显着的前景。
Despite technical advancements in breast radiation therapy, cardiac structures are still subject to significant levels of irradiation. As the use of adjuvant radiation therapy after breast-conserving surgery continues to improve survival for early breast cancer patients, the associated radiation-induced cardiac toxicities become increasingly relevant. Our primary aim was to evaluate the cardiac-sparing benefits of the deep inspiration breath-hold (DIBH) technique. An electronic literature search of the PubMed database from 1966 to July 2014 was used to identify articles published in English relating to the dosimetric benefits of DIBH. Studies comparing the mean heart dose of DIBH and free breathing treatment plans for left breast cancer patients were eligible to be included in the review. Studies evaluating the reproducibility and stability of the DIBH technique were also reviewed. Ten studies provided data on the benefits of DIBH during left breast irradiation. From these studies, DIBH reduced the mean heart dose by up to 3.4 Gy when compared to a free breathing approach. Four studies reported that the DIBH technique was stable and reproducible on a daily basis. According to current estimates of the excess cardiac toxicity associated with radiation therapy, a 3.4 Gy reduction in mean heart dose is equivalent to a 13.6% reduction in the projected increase in risk of heart disease. DIBH is a reproducible and stable technique for left breast irradiation showing significant promise in reducing the late cardiac toxicities associated with radiation therapy.