Advances in deep inspiration breath-hold technique for radiotherapy of right-sided breast cancer

Table 1 Study characteristics of included publications

Ref.	Year	n	Source/side	RT technique	DIBH system	Total dose	IMN	Key findings
Lee et al[12]	2026	32	Right-sided	IMRT vs VMAT	RPM	40 Gy/15 F	No	DIBH improves OAR sparing; IMRT lowest heart dose
Jiang et al[9]	2026	33	Right-sided	IMRT	OSMS	57.50 Gy/25 F; 50 Gy/25 F	Yes	Significant heart, RCA, liver, lung reductions
Semiz et al[11]	2025	40	Right-sided	3D-CRT/IMRT/VMAT	RPM	50 Gy/25 F	No/Yes	RCA reduction significant only with RNI
Mader et al[5]	2024	16	Right-sided	IMRT	RPM	40.05 Gy/15 F; 42.72 Gy/16 F	No	Contra breast Dmax increased; liver Dmax 40.3-17.5
Gough et al[10]	2024	14	Right-sided	IMRT	RPM	50 Gy/25 F	No	RCA dose reduction; MLD diff 2.8 Gy
Lai et al[16]	2023	31	Right-sided	VMAT	OSMS	57.50 Gy/50 F	Yes	SGRT-DIBH protects heart, RCA, lung, liver in RNI
Loap et al[15]	2023	15	Right-sided	VMAT	OSMS	50 Gy/25 F (40.05 Gy/15 F)	No	Liver dose reduced; heart/coronary NS
Peters et al[8]	2022	54	Right-sided	3D-CRT	OSMS	40.05-50 Gy/15-25 F; 46-50 Gy (IMN)	Yes	Largest RNI; all lung/Liver improved; heart NS
Demiral et al[14]	2021	36	Right-sided	IMRT	ABC	50 Gy/25 F; 60 Gy/30 F (boost)	No	Liver -61%, lung -26%
Haji et al[6]	2019	20	Right-sided	3D-CRT	OSMS	50 Gy/25 F	No	DIBH reduces liver, lung, heart
Conway et al[7]	2017	30	Right-sided	IMRT	OSMS	50 Gy/25 F; 45 Gy/25 F	No	70% achieved ≥ 5% V20 reduction
Essers et al[13]	2016	14	Right-sided	3D-CRT	RPM	42.56 Gy/16 F	Yes/No	Lung reduction only with IMN
Browne et al[29]	2020	31	Mixed L/R	3D-CRT	ABC	50 Gy/25 F; 42.5 Gy/16 F	Partial	No independent R-sided data
Mankinen et al[19]	2025	25	Left-sided (sim)	VMAT	RPM	40.05 Gy/15 F	No	DIR shows DVH subtraction overestimates lung benefit
Holt et al[21]	2021	10	Left-sided (sim)	VMAT vs t-IMRT	RPM	50 Gy/25 F	No	VMAT: Heart P = 0.53; recommends DIBH + VMAT
Pandeli et al[20]	2019	20	Left-sided (sim)	IMRT	RPM	40 Gy/15 F	Yes	Benefits most with RNI; simulated
Li et al[18]	2024	313	Meta-analysis	Mixed	ABC/OSMS/RPM	40-50 Gy	Various	Pooled SMD favors DIBH for heart, liver, lung

Rows are grouped by study type (right-sided cohorts first, then mixed laterality, left-sided simulations, and meta-analysis) and sorted by year within each group. Studies marked as “Left-sided (sim)” in the Source/Side column used left-sided breast cancer patient computed tomography datasets to simulate right-sided deep inspiration breath-hold treatment plans. Dosimetric results from these simulation studies may not be directly generalizable to real right-sided breast cancer patients due to anatomical differences (e.g., liver position, heart orientation). Their findings should be interpreted with caution in the context of right-sided breast cancer clinical practice. DIBH: Deep inspiration breath-hold; DVH: Dose-Volume Histogram; RT: Radiotherapy; IMN: Internal mammary nodes; OAR: Organs at risk; sim: Simulation based on left-sided computed tomography mirrored to right-sided anatomy; IMRT: Intensity-modulated radiotherapy; VMAT: Volumetric modulated arc therapy; RPM: Real-time position management; OSMS: Optical surface monitoring system; 3D-CRT: Three-dimensional conformal radiotherapy; RCA: Right coronary artery; RNI: Regional nodal irradiation; MLD: Mean lung dose; SGRT: Surface-guided radiotherapy; NS: Not significant; DIR: Deformable image registration; ABC: Active breathing control; SMD: Standardized mean difference.