Cardiorespiratory dose comparison among six radiotherapy regimens for patients with left-sided breast cancer

Abstract

There is uncertainty regarding the benefits and drawbacks of various radiation protocols for the treatment of left-sided breast cancer. To address this issue, we conducted a Bayesian network analysis. First, we searched several electronic databases for eligible literature. Next, we pooled the data from twelve studies concerning three-dimensional conformal radiation therapy (3D-CRT), intensity modulated radiation therapy (IMRT), and volumetric modulated arc therapy (VMAT), combined with either deep inspiratory breath-holding (DIBH) or free-breathing (FB) modalities. The integrated cardiac and pulmonary dosimetric indexes for all included treatments were compared using Bayesian networks. A direct meta-analysis indicated that for the two methods of 3D-CRT and IMRT, DIBH technology was more effective than FB in reducing the radiation dose to the heart and lungs. Additionally, according to the network results, DIBH was superior to FB in all six treatment options, regardless of whether the plan was 3D-CRT, IMRT, or VMAT. Besides, the combined data indicated that the FB-3D-CRT regimen had the weakest dosimetric advantage of all the treatments. Excluding FB-3D-CRT, each of the other five treatments had its own specific benefits. This is the first Bayesian study of several radiotherapy regimens for breast cancer patients on the left side, and the findings can be used to select appropriate radiotherapy programs for breast cancer patients.

Prediction Models of Cardiac Sparing during Deep Inspiration Breath-Hold in Left-sided Breast Cancer with Internal Mammary Node Irradiation

“…Deep inspiratory breath-hold (DIBH) is one of the most effective techniques to minimize the heart and left anterior descending artery (LAD) exposure on radiation by increasing the distance between the chest wall target and the heart [12,13]. However, not all patients bene t equally from DIBH, with approximately 19%-32% of patients receiving less bene t, and the technology requires more labor and time, which may discourage physicians from applying it routinely [14][15][16][17][18][19].…”