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Publication Name
World Journal of Translational Medicine
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2220-6132
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026.
World J Transl Med. Nov 28, 2026; 12(4): 126251
Published online Nov 28, 2026. doi: 10.5528/wjtm.126251
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]202632Right-sidedIMRT vs VMATRPM40 Gy/15 FNoDIBH improves OAR sparing; IMRT lowest heart dose
Jiang et al[9]202633Right-sidedIMRTOSMS57.50 Gy/25 F; 50 Gy/25 FYesSignificant heart, RCA, liver, lung reductions
Semiz et al[11]202540Right-sided3D-CRT/IMRT/VMATRPM50 Gy/25 FNo/YesRCA reduction significant only with RNI
Mader et al[5]202416Right-sidedIMRTRPM40.05 Gy/15 F; 42.72 Gy/16 FNoContra breast Dmax increased; liver Dmax 40.3-17.5
Gough et al[10]202414Right-sidedIMRTRPM50 Gy/25 FNoRCA dose reduction; MLD diff 2.8 Gy
Lai et al[16]202331Right-sidedVMATOSMS57.50 Gy/50 FYesSGRT-DIBH protects heart, RCA, lung, liver in RNI
Loap et al[15]202315Right-sidedVMATOSMS50 Gy/25 F (40.05 Gy/15 F)NoLiver dose reduced; heart/coronary NS
Peters et al[8]202254Right-sided3D-CRTOSMS40.05-50 Gy/15-25 F; 46-50 Gy (IMN)YesLargest RNI; all lung/Liver improved; heart NS
Demiral et al[14]202136Right-sidedIMRTABC50 Gy/25 F; 60 Gy/30 F (boost)NoLiver -61%, lung -26%
Haji et al[6]201920Right-sided3D-CRTOSMS50 Gy/25 FNoDIBH reduces liver, lung, heart
Conway et al[7]201730Right-sidedIMRTOSMS50 Gy/25 F; 45 Gy/25 FNo70% achieved ≥ 5% V20 reduction
Essers et al[13]201614Right-sided3D-CRTRPM42.56 Gy/16 FYes/NoLung reduction only with IMN
Browne et al[29]202031Mixed L/R3D-CRTABC50 Gy/25 F; 42.5 Gy/16 FPartialNo independent R-sided data
Mankinen et al[19]202525Left-sided (sim)VMATRPM40.05 Gy/15 FNoDIR shows DVH subtraction overestimates lung benefit
Holt et al[21]202110Left-sided (sim)VMAT vs t-IMRTRPM50 Gy/25 FNoVMAT: Heart P = 0.53; recommends DIBH + VMAT
Pandeli et al[20]201920Left-sided (sim)IMRTRPM40 Gy/15 FYesBenefits most with RNI; simulated
Li et al[18]2024313Meta-analysisMixedABC/OSMS/RPM40-50 GyVariousPooled 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.
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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]NoMedian (IQR)NRNRNR11.39.7< 0.00122.721.80.083IMRT subgroup
NoMedian (IQR)NRNRNR29.930.50.17030.529.90.170VMAT subgroup
Jiang et al[9]Nomean ± SD13.2 ± 1.510.0 ± 1.6< 0.00124.8 ± 3.120.1 ± 3.6< 0.00148.1 ± 5.440.5 ± 5.1< 0.001Whole-breast
Yesmean ± SD14.9 ± 0.813.3 ± 1.1< 0.00128.5 ± 1.624.9 ± 2.0< 0.00154.5 ± 4.148.6 ± 4.5< 0.001CW + IMN + SC
Semiz et al[11]Nomean ± SD11.239.190.00326.117.30.00139.935.70.023Breast-only
Yesmean ± SD18.9814.98< 0.00136.629.6< 0.00173.464.5< 0.001Breast + RNI
Mader et al[5]NoNR6.666.08< 0.00114.0211.50.007NRNRNRDensity 0.62 vs 0.59
Gough et al[10]NoMedian (IQR)17.014.20.00134.029.40.00153.047.90.004MLD diff 2.8 Gy (IQR 1.6-3.6)
Lai et al[16]Yesmean ± SD13.311.7< 0.0525.7 ± 1.920.6 ± 3.2< 0.0553.3 ± 3.048.3 ± 2.9< 0.05RNI patients
Lai et al[16]NoMedian (IQR)12.6511.40.10720.517.180.073NRNRNRConv fx; all NS
Peters et al[8]NoMedian (IQR)NRNRNRNRNRNRNRNRNRHypofract; lung vol +63%
YesMedian (IQR)19.7 (18.2-22.4)16.2 (14.5-18.0)< 0.00140.7 (35.4-46.0)31.7 (27.7-35.4)< 0.00161.2 (58.4-67.0)54.5 (50.8-59.0)< 0.001Largest RNI cohort
Demiral et al[14]NoNR12.79.5< 0.00121.915.8< 0.00130.224.0< 0.001Total MLD 7.06 vs 5.25
Haji et al[6]Nomean ± SD16.52 ± 2.4213.77 ± 2.710.000131.15 ± 3.7526.53 ± 4.030.0002NRNRNRIpsilt values
Essers et al[13]NoNR16.012.7< 0.00133.125.3< 0.00151.746.8< 0.00170% V20 reduction
YesNR18.5 ± 3.216.0 ± 2.8< 0.00542.6 ± 8.235.1 ± 6.3< 0.005NRNRNRFull RNI
Browne et al[29]NoNR11.2 ± 2.69.6 ± 2.1< 0.00524.5 ± 7.120.1 ± 6.2< 0.005NRNRNRBreast + SC
NoNSNSNSNSNSNSNSNSNSBreast-only; all NS
PartialNRNRNRNRNRNRNRNRNRNRNo R-sided values
Mankinen et al[19]NoMedian (IQR)10.7 (9.9-11.9)9.4 (8.3-10.1)< 0.001NRNRNRNRNRNRV16: 25.8% vs 21.3%
Holt et al[21]Nomean ± SD13.78 ± 1.3011.71 ± 1.050.00127.42 ± 3.1222.50 ± 2.970.00256.88 ± 4.2150.78 ± 3.980.004VMAT arm
Pandeli et al[20]Nomean ± SD18.79 ± 2.3315.27 ± 2.060.00241.20 ± 5.4632.78 ± 5.220.00256.77 ± 5.6950.14 ± 5.830.019t-IMRT arm
Yesmean ± SD18.9 ± 3.215.9 ± 2.30.00245.3 ± 13.332.9 ± 9.40.00291.6 ± 5.686.7 ± 7.10.01Breast + RNI
Pandeli et al[20]Nomean ± SDNSNSNSNSNSNSNSNSNSBreast-only; all NS
Li et al[18]VariousSMDNRNRNRNRNRNRNRNRNRTotal 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.
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Table 3 Liver dosimetric outcomes (deep inspiration breath hold vs free breathing)
Ref.
Dmean FB (Gy)
Dmean DIBH (Gy)
P value
Dmax FB (Gy)
Dmax DIBH (Gy)
P value
Volume metric
Volume FB
Volume DIBH (P value)
Lee et al[12] (IMRT)NRNRNRD2cc: 16.5D2cc: 2.7< 0.001V53.2%0% (< 0.001)
Lee et al[12] (VMAT)NRNRNRD2cc: 13.3D2cc: 3.0< 0.001V57.2%0.1% (< 0.001)
Jiang et al[9] (WB)5.6 ± 4.41.0 ± 1.6< 0.00145.1 ± 15.325.5 ± 17.7< 0.001V523.4%3.1% (< 0.001)
Jiang et al[9] (CW + IMN + SC)9.1 ± 4.12.6 ± 1.9< 0.00153.3 ± 1.439.8 ± 14.90.001V536.7%10.2% (< 0.001)
Semiz et al[11] (Breast)3.520.84< 0.001NRNRNRV205.8%0.7% (< 0.001)
Semiz et al[11] (Breast + RNI)6.781.96< 0.001NRNRNRV2010.8%1.5% (< 0.001)
Mader et al[5]2.10.80.00940.317.5< 0.001V3018.6 cm30 cm3 (0.001)
Gough et al[10]NRNRNRNRNRNRNRNRNR
Lai et al[16]9.172.81< 0.05NRNRNRNRNRNR
Loap et al[15] (Conv)2.540.870.01NRNRNRNRNRNR
Loap et al[15] (Hypofract)2.180.720.01NRNRNRNRNRNR
Peters et al[8] (V20)NRNRNR50.248.90.023V2078.8 mL23.9 mL (< 0.001)
Peters et al[8] (V30)NRNRNRNRNRNRV3058.1 mL14.6 mL (< 0.001)
Demiral et al[14]4.611.78< 0.001NRNRNRIn PTV234.4 cc57.7 cc (< 0.001)
Haji et al[6]5.6 ± 2.12.5 ± 1.40.0003NRNRNRV20 abs148.4 mL64.2 mL (0.0003)
Conway et al[7]NRNRNRNRNRNRV2549.6 cc7.3 cc
Essers et al[13]NRNRNRNRNRNRNRNRNR
Browne et al[29] (Mixed)NRNRNRNRNRNRNRNRNR
Mankinen et al[19] (sim)NRNRNRD1cc: 29.0D1cc: 4.6< 0.001NRNRNR
Holt et al[21] (VMAT)NRNRNR42.157.950.002NRNRNR
Holt et al[21] (t-IMRT)NRNRNR46.2018.900.008NRNRNR
Pandeli et al[20] (Breast)NRNRNR22.3 ± 15.79.2 ± 13.60.006V209.2 cc1.8 cc (0.03)
Pandeli et al[20] (RNI)NRNRNR31.3 ± 13.315.3 ± 9.80.002V2024.3 cc0.8 cc (0.02)
Li et al[18] (Meta)SMD: -1.15SMD: -1.15< 0.05NRNRNRV20 SMD: -1.01V20 SMD: -1.01
Dmean: Mean dose; Dmax: Maximum dose; D2cc: Dose to 2 cc; V5: Volume receiving ≥ 5 Gy; V25: Volume receiving ≥ 25 Gy; NR: Not reported; PTV: Planning target volume; FB: Free breathing; DIBH: Deep inspiration breath-hold; IMRT: Intensity-modulated radiotherapy; VMAT: Volumetric modulated arc therapy; WB: Whole breast; CW + IMN + SC: Chest wall + internal mammary nodes + supraclavicular; RNI: Regional nodal irradiation; t-IMRT: Tangential intensity-modulated radiotherapy.
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Table 4 Heart, right coronary artery, and other organs at risk dosimetric outcomes
Ref.
Ht Dmean FB (Gy)
Ht Dmean DIBH (Gy)
P value
Ht Dmax FB (Gy)
Ht Dmax DIBH (Gy)
P value
RCA Dmean FB (Gy)
RCA Dmean DIBH (Gy)
P value
RCA Dmax FB (Gy)
RCA Dmax DIBH (Gy)
P value
Other OAR notes
Lee et al[12] (IMRT)0.40.4NR0.40.40.103NRNRNRNRNRNRContra breast: NR
Lee et al[12] (VMAT)0.80.7< 0.0011.91.1< 0.001NRNRNRNRNRNRContra breast: NR
Jiang et al[9] (WB)2.4 ± 0.81.7 ± 0.4< 0.00120.8 ± 8.914.7 ± 9.00.0115.4 ± 2.73.1 ± 0.90.00510.0 ± 5.25.5 ± 3.20.006Contra Dmean 1.0 vs 0.9, P = 0.017
Jiang et al[9] (CW + IMN + SC)2.6 ± 1.31.9 ± 0.30.00117.9 ± 8.313.8 ± 5.80.0544.9 ± 3.53.4 ± 0.90.00210.4 ± 5.56.3 ± 2.00.004Contra Dmean NS
Semiz et al[11] (breast)NSNSNSNSNSNSNSNSNSNSNSNSContra: NR
Semiz et al[11] (breast + RNI)2.170.370.00923.9015.530.0017.895.120.00215.479.260.002Contra: NR
Mader et al[5]NRNRNR3.83.10.023NRNRNRNRNRNRContra Dmax 0.63 vs 1.3
Gough et al[10]NSNSNR13.111.40.0193.63.00.0028.66.80.002Contra: NR
Lai et al[16]2.251.71< 0.0516.679.28< 0.054.453.42< 0.0510.915.81< 0.05Contra: NR
Loap et al[15] (Conv)3.333.100.489NRNRNR4.214.060.599NRNRNRContra: NR
Loap et al[15] (Hypofract)2.582.410.489NRNRNRNRNRNRNRNRNRContra: NR
Peters et al[8]1.101.020.175NRNRNRNRNRNRNRNRNRContra: NR
Demiral et al[14]1.701.42< 0.001NRNRNRNRNRNRNRNRNRHeart V5: 0.7 vs 0.14%
Haji et al[6]1.49 ± 0.721.01 ± 0.310.002NRNRNRNRNRNRNRNRNRContra: NR
Conway et al[7]1.000.88< 0.001NRNRNRNRNRNRNRNRNRContra: NR
Essers et al[13] (Breast)NSNSNSNRNRNRNRNRNRNRNRNR
Essers et al[13] (RNI)1.57 ± 1.081.18 ± 0.520.07NRNRNRNRNRNRNRNRNR
Browne et al[29] (mixed)NRNRNRNRNRNRNRNRNRNRNRNRContra V5: 0.52 vs 0.22
Mankinen et al[19] (sim)1.91.4< 0.0018.77.3< 0.001NRNRNRNRNRNRContra V4 NS, Dmean P < 0.001
Holt et al[21] (VMAT)3.06 ± 0.612.49 ± 0.580.047NRNRNRNRNRNRNRNRNRContra t-IMRT NS
Holt et al[21] (t-IMRT)0.95 ± 0.250.93 ± 0.190.83NRNRNRNRNRNRNRNRNRContra: NR
Pandeli et al[20] (Breast)NSNSNSNSNSNSNSNSNSNSNSNSContra: NR
Pandeli et al[20] (RNI)2.6 ± 0.82.1 ± 0.70.0927.8 ± 7.621.5 ± 6.60.025.0 ± 2.53.5 ± 1.90.1011.6 ± 7.25.6 ± 2.90.03Contra: NR
Li et al[18] (Meta)SMD -0.63< 0.05NRNRNRNRNRNRNRNRNRContra: NR
Ht: Heart; RCA: Right coronary artery; Contra breast: Contralateral breast; NS: Not significant; NR: Not reported; Dmean: Mean dose; Dmax: Maximum dose; FB: Free breathing; DIBH: Deep inspiration breath-hold; OAR: Organs at risk; IMRT: Intensity-modulated radiotherapy; VMAT: Volumetric modulated arc therapy; WB: Whole breast; CW: Chest wall; IMN: Internal mammary nodes; SC: Supraclavicular; RNI: Regional nodal irradiation; t-IMRT: Tangential intensity-modulated radiotherapy.
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