Deep Inspiration Breath-Hold in the prevention of radiotherapy-induced cardiac injury

Abstract

Introduction: Breast-conserving surgery followed by adjuvant radiotherapy remains the gold standard in early-stage breast cancer treatment. However, incidental cardiac irradiation increases the risk of ischemic heart disease, the leading non-malignant cause of death among these patients. Objective: To identify evidence-based implications of the Deep Inspiration Breath-Hold (DIBH) technique for preventing cardiac injury associated with adjuvant radiotherapy. Methods: A scoping review was conducted in accordance with Joanna Briggs Institute guidelines. The PubMed, LILACS and Web of Science databases were searched for studies reporting the application of DIBH within the context defined by this review. Results: Fifteen relevant studies were selected, all assessing DIBH for the prevention of cardiotoxicity secondary to adjuvant radiotherapy. Deep inspiration increases lung volume, expanding the thoracic cavity and displacing the heart to the right and downward, thereby moving the heart out of the radiation field and reducing cardiac exposure. Conclusion: The results presented across multiple studies indicate that the use of DIBH in clinical practice consistently reduced cardiac irradiation without compromising target coverage.