title: The cardiac dose-sparing benefits of deep inspiration breath-hold in left breast irradiation: a systematic review.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  DIBH is a reproducible and stable technique for left breast irradiation showing significant promise in reducing the late cardiac toxicities associated with radiation therapy.
authors.affiliation: Epworth Radiation Oncology, Level 4, The Epworth Centre Richmond, Victoria ; Department of Medical Imaging & Radiation Sciences, Faculty of Medicine, School of Biomedical Sciences, Nursing & Health Sciences, Monash University Clayton, Victoria.
authors.forename: Lloyd M
authors.initials: LM
authors.lastname: Smyth
authors.affiliation: Department of Medical Imaging & Radiation Sciences, Faculty of Medicine, School of Biomedical Sciences, Nursing & Health Sciences, Monash University Clayton, Victoria.
authors.forename: Kellie A
authors.initials: KA
authors.lastname: Knight
authors.affiliation: Epworth Radiation Oncology, Level 4, The Epworth Centre Richmond, Victoria.
authors.forename: Yolanda K
authors.initials: YK
authors.lastname: Aarons
authors.affiliation: Epworth Radiation Oncology, Level 4, The Epworth Centre Richmond, Victoria.
authors.forename: Jason
authors.initials: J
authors.lastname: Wasiak
keywords: Adverse effects; breast neoplasms; heart; radiotherapy; review