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

Table 2 Ipsilateral lung dosimetric outcomes (deep inspiration breath hold vs free breathing)

Ref.	IMN	Stat method	Dmean FB (Gy)	Dmean DIBH (Gy)	P value	V20 FB (%)	V20 DIBH (%)	P value	V5 FB (%)	V5 DIBH (%)	P value	Notes
Lee et al[12]	No	Median (IQR)	NR	NR	NR	11.3	9.7	< 0.001	22.7	21.8	0.083	IMRT subgroup
	No	Median (IQR)	NR	NR	NR	29.9	30.5	0.170	30.5	29.9	0.170	VMAT subgroup
Jiang et al[9]	No	mean ± SD	13.2 ± 1.5	10.0 ± 1.6	< 0.001	24.8 ± 3.1	20.1 ± 3.6	< 0.001	48.1 ± 5.4	40.5 ± 5.1	< 0.001	Whole-breast
	Yes	mean ± SD	14.9 ± 0.8	13.3 ± 1.1	< 0.001	28.5 ± 1.6	24.9 ± 2.0	< 0.001	54.5 ± 4.1	48.6 ± 4.5	< 0.001	CW + IMN + SC
Semiz et al[11]	No	mean ± SD	11.23	9.19	0.003	26.1	17.3	0.001	39.9	35.7	0.023	Breast-only
	Yes	mean ± SD	18.98	14.98	< 0.001	36.6	29.6	< 0.001	73.4	64.5	< 0.001	Breast + RNI
Mader et al[5]	No	NR	6.66	6.08	< 0.001	14.02	11.5	0.007	NR	NR	NR	Density 0.62 vs 0.59
Gough et al[10]	No	Median (IQR)	17.0	14.2	0.001	34.0	29.4	0.001	53.0	47.9	0.004	MLD diff 2.8 Gy (IQR 1.6-3.6)
Lai et al[16]	Yes	mean ± SD	13.3	11.7	< 0.05	25.7 ± 1.9	20.6 ± 3.2	< 0.05	53.3 ± 3.0	48.3 ± 2.9	< 0.05	RNI patients
Lai et al[16]	No	Median (IQR)	12.65	11.4	0.107	20.5	17.18	0.073	NR	NR	NR	Conv fx; all NS
Peters et al[8]	No	Median (IQR)	NR	NR	NR	NR	NR	NR	NR	NR	NR	Hypofract; lung vol +63%
	Yes	Median (IQR)	19.7 (18.2-22.4)	16.2 (14.5-18.0)	< 0.001	40.7 (35.4-46.0)	31.7 (27.7-35.4)	< 0.001	61.2 (58.4-67.0)	54.5 (50.8-59.0)	< 0.001	Largest RNI cohort
Demiral et al[14]	No	NR	12.7	9.5	< 0.001	21.9	15.8	< 0.001	30.2	24.0	< 0.001	Total MLD 7.06 vs 5.25
Haji et al[6]	No	mean ± SD	16.52 ± 2.42	13.77 ± 2.71	0.0001	31.15 ± 3.75	26.53 ± 4.03	0.0002	NR	NR	NR	Ipsilt values
Essers et al[13]	No	NR	16.0	12.7	< 0.001	33.1	25.3	< 0.001	51.7	46.8	< 0.001	70% V20 reduction
	Yes	NR	18.5 ± 3.2	16.0 ± 2.8	< 0.005	42.6 ± 8.2	35.1 ± 6.3	< 0.005	NR	NR	NR	Full RNI
Browne et al[29]	No	NR	11.2 ± 2.6	9.6 ± 2.1	< 0.005	24.5 ± 7.1	20.1 ± 6.2	< 0.005	NR	NR	NR	Breast + SC
	No		NS	NS	NS	NS	NS	NS	NS	NS	NS	Breast-only; all NS
	Partial	NR	NR	NR	NR	NR	NR	NR	NR	NR	NR	No R-sided values
Mankinen et al[19]	No	Median (IQR)	10.7 (9.9-11.9)	9.4 (8.3-10.1)	< 0.001	NR	NR	NR	NR	NR	NR	V16: 25.8% vs 21.3%
Holt et al[21]	No	mean ± SD	13.78 ± 1.30	11.71 ± 1.05	0.001	27.42 ± 3.12	22.50 ± 2.97	0.002	56.88 ± 4.21	50.78 ± 3.98	0.004	VMAT arm
Pandeli et al[20]	No	mean ± SD	18.79 ± 2.33	15.27 ± 2.06	0.002	41.20 ± 5.46	32.78 ± 5.22	0.002	56.77 ± 5.69	50.14 ± 5.83	0.019	t-IMRT arm
	Yes	mean ± SD	18.9 ± 3.2	15.9 ± 2.3	0.002	45.3 ± 13.3	32.9 ± 9.4	0.002	91.6 ± 5.6	86.7 ± 7.1	0.01	Breast + RNI
Pandeli et al[20]	No	mean ± SD	NS	NS	NS	NS	NS	NS	NS	NS	NS	Breast-only; all NS
Li et al[18]	Various	SMD	NR	NR	NR	NR	NR	NR	NR	NR	NR	Total SMD: -0.79; R: -0.86

NS: Not significant; NR: Not reported; IMN: Internal mammary nodes; Dmean: Mean dose; V20: Volume receiving ≥ 20 Gy; V5: Volume receiving ≥ 5 Gy; SMD: Standardized mean difference; RNI: Regional nodal irradiation; DIBH: Deep inspiration breath-hold; IMN: Internal mammary nodes; FB: Free breathing; IMRT: Intensity-modulated radiotherapy; IQR: Interquartile range; VMAT: Volumetric modulated arc therapy; CW: Chest wall; SC: Supraclavicular; MLD: Mean lung dose; t-IMRT: Tangential intensity-modulated radiotherapy.