Meta-analysis of deep inspiration breath hold (DIBH) versus free breathing (FB) in postoperative radiotherapy for left-side breast cancer

  • Junming LaiEmail author
  • Shuang Hu
  • Yongbiao Luo
  • Rikui Zheng
  • Qibao Zhu
  • Pingliang Chen
  • Beiyuan Chi
  • Yunhui Zhang
  • Fangyan Zhong
  • Xin Long
Original Article



This meta-analysis evaluates the difference in deep inspiration breath hold (DIBH) versus free breathing (FB) for patients receiving postoperative radiotherapy for left breast cancer and provides a useful reference for clinical practice.


The relevant controlled trials of DIBH versus FB in postoperative radiotherapy for left-side breast cancer were retrieved from the databases of PubMed, Science Direct, Cochrane Library, and Web of Science databases. The principal outcome of interest was heart dose, left anterior descending coronary artery (LADCA) dose, and left lung dose and target coverage. We calculated summary standardized mean difference (SMD) and 95% confidence intervals (CI). The meta-analysis was performed using RevMan 5.3 software.


The analysis included 1019 patients from 12 observational studies, of which 576 cases were in the DIBH group and 443 cases in the FB group. Compared with the FB group, the DIBH group can have lower heart dose, left anterior descending coronary artery (LADCA) dose, and left lung dose more effectively, and the difference was statistically significant (heart dose, SMD = − 1.36, 95% CI − 1.64 ~ − 1.09, P < 0.01. LADCA dose, SMD = − 1.45, 95% CI − 1.62 ~ − 1.27, P < 0.01. Left lung dose, SMD = − 0.52, 95% CI − 0.81 ~ − 0.23, P < 0.01). There was no significant difference in target coverage between the two groups (SMD = 0.03, 95% CI − 0.11 ~ 0.18, P = 0.64).


By this meta-analysis, we found that implementation of DIBH in postoperative radiotherapy for left-side breast cancer can reduce irradiation of heart dose, LADCA dose and left lung dose, without compromising target coverage.


Breast cancer Radiotherapy Deep inspiration breath hold Meta-analysis 



The authors thank Senxiang Yan (PhD, Radiotherapy Center, the First Affiliated Hospital of Zhejiang University) for providing assistance and contributing to revisions.

Author contributions

JL performed the planning study and the statistical analysis and drafted the manuscript. SH, YL, RZ, QZ, and PC participated in information and data collection. MZ, YZ, and FZ helped to draft the manuscript. All authors read and approved the final manuscript.


This study was supported by grants from The First batch of Yiwu Science and Technology Project in 2019 [Grant Number: 19-3-03].

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.


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Copyright information

© The Japanese Breast Cancer Society 2019

Authors and Affiliations

  • Junming Lai
    • 1
    Email author
  • Shuang Hu
    • 2
  • Yongbiao Luo
    • 1
  • Rikui Zheng
    • 1
  • Qibao Zhu
    • 1
  • Pingliang Chen
    • 1
  • Beiyuan Chi
    • 1
  • Yunhui Zhang
    • 3
  • Fangyan Zhong
    • 4
  • Xin Long
    • 5
  1. 1.Department of Radiation OncologyYiwu Central Hospital, The Affiliated Yiwu Hospital of Wenzhou Medical UniversityYiwuPeople’s Republic of China
  2. 2.Department of General MedicineYiwu Central Hospital, The Affiliated Yiwu Hospital of Wenzhou Medical UniversityYiwuPeople’s Republic of China
  3. 3.Department of PediatricsYiwu Central Hospital, The Affiliated Yiwu Hospital of Wenzhou Medical UniversityYiwuPeople’s Republic of China
  4. 4.Department of Medicine of the Graduate SchoolNanchang UniversityNanchangPeople’s Republic of China
  5. 5.Department of Medicine of the Graduate SchoolWuhan UniversityWuhanPeople’s Republic of China

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