Cardiac dose in radiotherapy treatments for left-sided breast cancer: use of the Deep Inspiration Breath Hold technique




Breast Neoplasms; Radiotherapy; Respiration; Radiation Dosage; Cardiotoxicity.


Introduction: radiotherapy treatment for left-sided breast cancer has radiation-induced cardiotoxicity as a consequence. The Deep Inspiration Breath Hold (DIBH) technique arose from the need to minimize cardiac doses. Objective: to describe the doses to cardiac structures by means of the Dose Volume Histogram (DVH) in radiotherapy treatment for left-sided breast cancer with the DIBH technique. Methodology: the research is characterized as a case study with multiple analysis units, typified as descriptive, retrospective in nature and with a quantitative approach. Results: the sample was composed of five analysis units. The average cardiac dose for the DIBH technique was 6 Gy; and for the left anterior descending coronary artery, it was 14.8 Gy. Four analysis units benefited the most from the technique, the result of which is justified by the conservative surgical modality, while one unit showed the least benefit, since it performed mastectomy.  Conclusion: DIBH is an alternative to reduce cardiac toxicity in women undergoing radiation therapy for left-sided breast cancer, especially in individuals with other risk factors associated with heart disease.


Arslan, A., Aktas, E., Sengul, B., & Tekin, B. (2021). Dosimetric evaluation of left ventricle and left anterior descending artery in left breast radiotherapy. Radiologia Medica, 126(1), 14-21.

Beaton, L., Bergman, A., Nichol, A., Aparicio, M., Wong, G., Gondara, L., Speers, C., Weir, L., Davis, M., & Tyldesley, S. (2019). Cardiac death after breast radiotherapy and the QUANTEC cardiac guidelines. Clinical and Translational Radiation Oncology, 19, 39-45.

Becker-Schiebe, M., Stockhammer, M., Hoffmann, W., Wetzel, F., & Franz, H. (2016). Does mean heart dose sufficiently reflect coronary artery exposure in left-sided breast cancer radiotherapy? Strahlentherapie Und Onkologie, 192(9), 624–631.

Bentzen, S. M., Constine, L. S., Deasy, J. O., Eisbruch, A., Jackson, A., Marks, L. B., ten Haken, R. K., & Yorke, E. D. (2010). Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC): An Introduction to the Scientific Issues. International Journal of Radiation Oncology Biology Physics, 76(3 SUPPL), S3–S9.

Bergom, C., Currey, A., Desai, N., Tai, A., & Strauss, J. B. (2018). Deep inspiration breath hold: Techniques and advantages for cardiac sparing during breast cancer irradiation. In Frontiers in Oncology, Vol. 8, Issue APR, 87.

Campos, L., Santos, J. R., Souza, D. do N., & Attie, M. R. P. (2021). Aspectos relevantes do hipofracionamento na radioterapia de mama e de próstata. Research, Society and Development, 10(5), e24910514904.

Cesário, J. M. dos S., Flauzino, Vi. H. de P., Hernandes, L. de O., Gomes, D. M., & Vitorino, P. G. da S. (2021). Assistência de enfermagem aos pacientes com cardiotoxicidade induzidas por quimioterápicos. Research, Society and Development, 10(6), e34210615355.

Dincoglan, F., Beyzadeoglu, M., Sager, O., Oysul, K., Kahya, Y. E., Gamsiz, H., Uysal, B., Demiral, S., Dirican, B., & Surenkok, S. (2013). Dosimetric evaluation of critical organs at risk in mastectomized left-sided breast cancer radiotherapy using breath-hold technique. Tumori, 99(1),76–82.

Drost, L., Yee, C., Lam, H., Zhang, L., Wronski, M., McCann, C., Lee, J., Vesprini, D., Leung, E., & Chow, E. (2018). A Systematic Review of Heart Dose in Breast Radiotherapy. In Clinical Breast Cancer, Vol. 18, Issue 5, e819–e824.

Duhaini, I., Shahine, B., Zeidan, Y., Mkanna, A., Maarouf, A., & Korek, M. (2021). The effectiveness of the DIBH technique in protecting the heart of radiotherapy breast cancer patients treated at the American University of Beirut Medical Center in Lebanon. Health and Technology, 11, 851–857

Falco, M., Masojć, B., MacAła, A., Łukowiak, M., Woźniak, P., & Malicki, J. (2021). Deep inspiration breath hold reduces the mean heart dose in left breast cancer radiotherapy. Radiology and Oncology, 55(2), 212-220.

Feng, M., Moran, J. M., Koelling, T., Chughtai, A., Chan, J. L., Freedman, L., Hayman, J. A., Jagsi, R., Jolly, S., Larouere, J., Soriano, J., Marsh, R., & Pierce, L. J. (2011). Development and validation of a heart atlas to study cardiac exposure to radiation following treatment for breast cancer. International Journal of Radiation Oncology Biology Physics, 79(1), 10–18.

Harry, T., Rahn, D., Semenov, D., Gu, X., Yashar, C., Einck, J., Jiang, S., & Cerviño, L. (2016). Cardiac dosimetric evaluation of deep inspiration breath-hold level variances using computed tomography scans generated from deformable image registration displacement vectors. Medical Dosimetry, 41(1), 22–27.

Hayden, A. J., Rains, M., & Tiver, K. (2012). Deep inspiration breath hold technique reduces heart dose from radiotherapy for left-sided breast cancer. Journal of Medical Imaging and Radiation Oncology, 56(4), 464–472.

Instituto Nacional de Câncer José Alencar Gomes da Silva. (2019). Estimativa 2020: Incidência de Câncer no Brasil. Ministério da Saúde.

Kirova, Y., Tallet, A., Aznar, M. C., Loap, P., Bouali, A., & Bourgier, C. (2020). Radio-induced cardiotoxicity: From physiopathology and risk factors to adaptation of radiotherapy treatment planning and recommended cardiac follow-up. In Cancer/Radiotherapie, Vol. 24, Issues 6–7, 576–585.

Lai, J., Hu, S., Luo, Y., Zheng, R., Zhu, Q., Chen, P., Chi, B., Zhang, Y., Zhong, F., & Long, X. (2020). Meta-analysis of deep inspiration breath hold (DIBH) versus free breathing (FB) in postoperative radiotherapy for left-side breast cancer. Breast Cancer, 27(2), 299–307.

Lin, A., Sharieff, W., Juhasz, J., Whelan, T., & Kim, D. H. (2017). The benefit of deep inspiration breath hold: evaluating cardiac radiation exposure in patients after mastectomy and after breast-conserving surgery. Breast Cancer, 24(1), 86–91.

Macrie, B. D., Donnelly, E. D., Hayes, J. P., Gopalakrishnan, M., Philip, R. T., Reczek, J., Prescott, A., & Strauss, J. B. (2015). A cost-effective technique for cardiac sparing with deep inspiration-breath hold (DIBH). Physica Medica, 31(7), 733–737.

National Cancer Institute (NCI), & Radiation Therapy Oncology Group. (2016). A Randomized Phase III Clinical Trial Evaluating Post-Mastectomy Chestwall and Regional Nodal XRT and Post-Lumpectomy Regional Nodal XRT in Patients with Positive Axillary Nodes Before Neoadjuvant Chemotherapy Who Convert to Pathologically Negative Axillary Nodes After Neoadjuvant Chemotherapy - NSABP B-51/RTOG 1304.

Melo, N. (2019). Proporção da Utilização de Radioterapia no Tratamento Oncológico dos Pacientes Atendidos no SUS. Observatório de Oncologia.

Piroth, M. D., Baumann, R., Budach, W., Dunst, J., Feyer, P., Fietkau, R., Haase, W., Harms, W., Hehr, T., Krug, D., Röser, A., Sedlmayer, F., Souchon, R., Wenz, F., & Sauer, R. (2019). Heart toxicity from breast cancer radiotherapy. Strahlentherapie Und Onkologie, 195(1), 1–12.

Poitevin-Chacón, A., Chávez-Nogueda, J., Prudencio, R. R., Fernández, A. C., Laguna, A. R., Linares, J., & Martínez, J. C. (2018). Dosimetry of the left anterior descending coronary artery in left breast cancer patients treated with postoperative external radiotherapy. Reports of Practical Oncology and Radiotherapy, 23(2), 91–96.

Sakyanun, P., Saksornchai, K., Nantavithya, C., Chakkabat, C., & Shotelersuk, K. (2020). The effect of deep inspiration breath-hold technique on left anterior descending coronary artery and heart dose in left breast irradiation. Radiation Oncology Journal, 38(3), 181–188.

Silva, C. da, Dorow, P. F., Borges, L. M., Huhn, A., Ribeiro, G., Thiao, E. L. de S., & Nunes, C. D. D. (2019). Simulation and treatment left with the DIBH tecnique. International Journal of Develompment Research, 9(10), 30781–30784.

Simonetto, C., Eidemüller, M., Gaasch, A., Pazos, M., Schönecker, S., Reitz, D., Kääb, S., Braun, M., Harbeck, N., Niyazi, M., Belka, C., & Corradini, S. (2019). Does deep inspiration breath-hold prolong life? Individual risk estimates of ischaemic heart disease after breast cancer radiotherapy. Radiotherapy and Oncology, 131, 202–207.

Waks, A. G., & Winer, E. P. (2019). Breast Cancer Treatment: A Review. In JAMA - Journal of the American Medical Association, Vol. 321, Issue 3, 288–300.

Yin, R. K. (2015) . Estudo de Caso: Planejamento e Métodos. (5 ed.). Bookman.

Zhao, F., Shen, J., Lu, Z., Luo, Y., Yao, G., Bu, L., Ge, J., Yang, X., Ning, L., & Yan, S. (2018). Abdominal DIBH reduces the cardiac dose even further: A prospective analysis. Radiation Oncology, 13(1), 116.



How to Cite

SILVA, C. da; DOROW, P. F. .; MÜLLER, J. dos S. .; PIEDADE, P. A. . Cardiac dose in radiotherapy treatments for left-sided breast cancer: use of the Deep Inspiration Breath Hold technique . Research, Society and Development, [S. l.], v. 10, n. 10, p. e308101018773, 2021. DOI: 10.33448/rsd-v10i10.18773. Disponível em: Acesso em: 23 feb. 2024.



Health Sciences