DIBH reduces radiation dose to heart and lungs in left-sided breast cancer VMAT

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PloS one Published April 6, 2026 Medically reviewed April 26, 2026 Study authors: Chiang Pin-Yi, Huang Pin-Jui, Hung Chao-Hsiung, Lin Ching-Po, Chang Chih-Chia PubMed ↗ DOI ↗ By Dr. Julia Lee, PhD · Oncology, Genomics & Drug Development

Key Takeaway

Consider DIBH for dosimetric advantages in left-sided breast cancer VMAT, but clinical benefit remains unconfirmed.

This meta-analysis and systematic review examined 11 studies comparing deep inspiration breath hold (DIBH) versus free breathing (FB) during volumetric modulated arc therapy (VMAT) for left-sided breast cancer. The analysis focused on radiation dose to organs at risk but did not report clinical outcomes, follow-up duration, or study settings.

DIBH was associated with lower mean radiation doses across all measured organs. The standardized mean difference (SMD) was -1.40 Gy for heart dose, -1.65 Gy for left anterior descending coronary artery dose, -0.57 Gy for ipsilateral lung dose, -0.46 Gy for contralateral lung dose, and -0.20 Gy for contralateral breast dose. The analysis did not provide absolute dose values or confidence intervals for these estimates.

No safety, tolerability, or adverse event data were reported. The review did not describe study limitations, funding sources, or conflicts of interest. While the dosimetric reductions suggest potential clinical benefits for reducing cardiac and pulmonary toxicity, the absence of clinical outcome data limits definitive conclusions about patient benefit.

The authors recommend DIBH for patients undergoing VMAT, particularly with tumor bed boost or without nodal irradiation, based on its effectiveness in reducing heart dose. However, clinicians should interpret these findings cautiously as they represent dosimetric associations rather than demonstrated clinical outcomes.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedJan 2026

PMID41911243

View Original Abstract ↓

This meta-analysis aimed to determine the effect of deep inspiration breath hold (DIBH) compared with free breathing (FB) on dose to the organs at risk (OARs), such as the heart, left anterior descending (LAD) coronary artery, lungs, and contralateral breast, in patients with left-sided breast cancer treated with volumetric modulated arc therapy (VMAT). PubMed, EMBASE, and Cochrane Library electronic databases were searched for studies until March 21, 2024. Cochrane RevMan version 5.4 statistical software was used to analyze 11 eligible studies. Standard mean difference (SMD), with 95% confidence interval for OAR dose reductions, was calculated. DIBH considerably resulted in lower mean doses (Dmean) to the heart (SMD = -1.40 Gy), LAD (SMD = -1.65 Gy), ipsilateral lung (SMD = -0.57 Gy), contralateral lung (SMD = -0.46 Gy), and contralateral breast (SMD = -0.20 Gy). If VMAT was delivered with an arc of >180O, the heart Dmean reduction was even more pronounced. Subgroup analysis revealed that DIBH efficiently reduced heart Dmean, especially in patients with tumor bed boost without nodal irradiation. DIBH was effective in reducing dose to OARs in patients treated with VMAT in all subgroups, i.e., breast only, with/without tumor bed boost, and with/without nodal irradiation. Furthermore, the use of DIBH is strongly recommended for patients undergoing VMAT with a tumor bed boost or without nodal irradiation, as it is more effective in reducing heart Dmean than FB.