{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T04:51:36Z","timestamp":1777351896966,"version":"3.51.4"},"reference-count":31,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2023,12,11]],"date-time":"2023-12-11T00:00:00Z","timestamp":1702252800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Multimodality is required for the treatment of breast cancer. Surgery, radiation (RT), and systemic therapy were traditionally used. Pharmacotherapy includes different drug mechanisms, such as chemotherapy, hormone therapy, and targeted therapies, alone or in combination with radiotherapy. While radiation offers numerous benefits, it also has certain harmful risks. such as cardiac and pulmonary toxicity, lymphedema, and secondary cancer. Modern radiation techniques have been developed to reduce organs at risk (OAR) doses. Materials and Methods: This study is a prospective feasibility trial conducted at the Fayium Oncology Center on patients with left breast cancer receiving adjuvant locoregional radiotherapy after either breast conservative surgery (BCS) or modified radical mastectomy (MRM). This study aimed to assess the proportion of patients who are fit both physically and intellectually to undergo breast radiotherapy using the deep inspiratory breath-holding (DIBH) technique, comparing different dosimetric outcomes between the 3D dimensional conformal with DIBH and 4D-CT IMRT plans of the same patient. Results: D95 of the clinical target volume (CTV) of the target is significantly higher in the 3D DIBH plan than in the IMRT plan, with an average of 90.812% vs. 86.944%. The dosimetry of the mean heart dose (MHD) in the 4D-CT IMRT plan was significantly lower than in the 3D conformal with the DIBH plan (2.6224 vs. 4.056 Gy, p &lt; 0.0064), and no significant difference between the two plans regarding mean left anterior descending artery (LAD) (14.696 vs. 13.492 Gy, p &lt; 0.58), maximum LAD (39.9 vs. 43.5 Gy, p &lt; 0.35), and V20 of the ipsilateral lung (18.66% vs. 16.306%, p &lt; 0.88) was observed. Internal mammary chain (IMC) irradiation was better in the 4D-CT IMRT plan. Conclusions: Radiotherapy of the breast and chest wall with the 4D-CT IMRT technique appears not to be inferior to the 3D conformal with the DIBH technique and can be used as an alternative to the 3D conformal with the DIBH technique in patients meeting the exclusion criteria for performing the DIBH maneuver concerning coverage to target volumes or unacceptably high doses to OAR.<\/jats:p>","DOI":"10.3390\/cancers15245799","type":"journal-article","created":{"date-parts":[[2023,12,11]],"date-time":"2023-12-11T13:18:21Z","timestamp":1702300701000},"page":"5799","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["A Comparison of 3D Conformal and Deep Inspiratory Breath Holding vs. 4D-CT Intensity-Modulated Radiation Therapy for Patients with Left Breast Cancer"],"prefix":"10.3390","volume":"15","author":[{"given":"Moustafa","family":"Aldaly","sequence":"first","affiliation":[{"name":"Department of Clinical Oncology, Faculty of Medicine, Kasr AL Ainy, Cairo University, Cairo 11956, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Azza","family":"Hussien","sequence":"additional","affiliation":[{"name":"Department of Clinical Oncology, Faculty of Medicine, Beni-Suef University, Beni Suef 62511, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Inas Mohsen","family":"El-nadi","sequence":"additional","affiliation":[{"name":"Department of Clinical Oncology, Faculty of Medicine, Beni-Suef University, Beni Suef 62511, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nabila Ibrahim","family":"Laz","sequence":"additional","affiliation":[{"name":"Department of Chest, Faculty of Medicine, Beni-Suef University, Beni Suef 62511, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6421-5970","authenticated-orcid":false,"given":"Amira S. A.","family":"Said","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, Faculty of Pharmacy, Beni-Suef University, Beni Suef 62511, Egypt"},{"name":"Department of Clinical Pharmacy, College of Pharmacy, Al Ain University, Abu Dhabi P.O. Box 112612, United Arab Emirates"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0344-4056","authenticated-orcid":false,"given":"Mohammad M.","family":"Al-Ahmad","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, College of Pharmacy, Al Ain University, Abu Dhabi P.O. Box 112612, United Arab Emirates"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0503-685X","authenticated-orcid":false,"given":"Raghda R. S.","family":"Hussein","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, Faculty of Pharmacy, Beni-Suef University, Beni Suef 62511, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2229-9969","authenticated-orcid":false,"given":"Al Shaimaa Ibrahim","family":"Rabie","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, Faiyum Oncology Center, Faiyum 63511, Egypt"},{"name":"Department of Clinical Nutrition, Health Insurance Authority, Faiyum 63511, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed Hassan","family":"Shaaban","sequence":"additional","affiliation":[{"name":"Department of Clinical Oncology, Faculty of Medicine, Beni-Suef University, Beni Suef 62511, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,11]]},"reference":[{"key":"ref_1","unstructured":"(2023, September 01). GLOBOCAN 2020: New Global Cancer Data. Available online: https:\/\/www.uicc.org\/news\/globocan-2020-new-global-cancer-data."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"7","DOI":"10.3322\/caac.21654","article-title":"Cancer statistics, 2021","volume":"71","author":"Siegel","year":"2021","journal-title":"CA A Cancer J. Clin."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"djv048","DOI":"10.1093\/jnci\/djv048","article-title":"Annual report to the nation on the status of cancer, 1975\u20132011, featuring incidence of breast cancer subtypes by race\/ethnicity, poverty, and state","volume":"107","author":"Kohler","year":"2015","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_4","first-page":"165","article-title":"The effects of population-based mammography screening starting between age 40 and 50 in the presence of adjuvant systemic therapy","volume":"137","author":"Heijnsdijk","year":"2014","journal-title":"Int. J. Cancer"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"dju289","DOI":"10.1093\/jnci\/dju289","article-title":"Effects of screening and systemic adjuvant therapy on ER-specific us breast cancer mortality","volume":"106","author":"Munoz","year":"2014","journal-title":"JNCI J. Natl. Cancer Inst."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s10549-022-06759-1","article-title":"A systematic review of multimodal prehabilitation in breast cancer","volume":"197","author":"Toohey","year":"2023","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"449","DOI":"10.2147\/IJWH.S55552","article-title":"Benefits, risks, and safety of external beam radiation therapy for breast cancer","volume":"7","author":"Halyard","year":"2015","journal-title":"Int. J. Women\u2019s Health"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1227","DOI":"10.1056\/NEJMoa020989","article-title":"Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer","volume":"347","author":"Veronesi","year":"2002","journal-title":"N. Engl. J. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1056\/NEJMoa1209825","article-title":"Risk of ischemic heart disease in women after radiotherapy for breast cancer","volume":"368","author":"Darby","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_10","unstructured":"Halperin, E.C., Brady, L.W., Perez, C.A., and Wazer, D.E. (2013). Perez & Brady\u2019s Principles and Practice of Radiation Oncology, Lippincott Williams & Wilkins."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/j.prro.2016.10.011","article-title":"Deep inspiration breath-hold produces a clinically meaningful reduction in ipsilateral lung dose during locoregional radiation therapy for some women with right-sided breast cancer","volume":"7","author":"Conway","year":"2017","journal-title":"Pract. Radiat. Oncol."},{"key":"ref_12","first-page":"777","article-title":"Investigation of Thermal Decomposition Behavior of Cerium (III) Acetate Hydrate","volume":"25","author":"Arabaci","year":"2012","journal-title":"Gazi Univ. J. Sci."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Eber, J., Blondet, C., Schmitt, M., Cox, D.G., Vit, C., Le F\u00e8vre, C., Antoni, D., Hubele, F., and Noel, G. (2023). Efficacity of Deep Inspiration Breath Hold and Intensity-Modulated Radiotherapy in Preventing Perfusion Defect for Left Sided Breast Cancer (EDIPE): A Prospective Cohort Study Protocol. Cancers, 15.","DOI":"10.3390\/cancers15092467"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"703","DOI":"10.3109\/0284186X.2013.765064","article-title":"Delineation of target volumes and organs at risk in adjuvant radiotherapy of early breast cancer: National guidelines and contouring atlas by the Danish Breast Cancer Cooperative Group","volume":"52","author":"Nielsen","year":"2013","journal-title":"Acta Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"S145","DOI":"10.1102\/1470-7330.2011.9036","article-title":"Advances in radiotherapy: From 2D to 4D","volume":"11","author":"Hoyer","year":"2011","journal-title":"Cancer Imaging"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1016\/j.prro.2013.10.006","article-title":"Introduction of moderate deep inspiration breath hold for radiation therapy of left breast: Initial experience of a regional cancer center","volume":"4","author":"Comsa","year":"2014","journal-title":"Pract. Radiat. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"196","DOI":"10.5301\/tj.5000402","article-title":"Hypofractionated whole-breast radiotherapy and concomitant boost after breast conservation in elderly patients","volume":"102","author":"Cante","year":"2016","journal-title":"Tumori J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1007\/s00066-011-0015-x","article-title":"The ICRU Report 83: Prescribing, recording and reporting photon-beam intensity-modulated radiation therapy (IMRT)","volume":"188","author":"Hodapp","year":"2012","journal-title":"Strahlenther. Onkol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"S130","DOI":"10.1016\/j.ijrobp.2009.04.094","article-title":"radiation dose\u2013volume effects and the penile bulb","volume":"76","author":"Roach","year":"2010","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_20","first-page":"123","article-title":"Tolerance of normal tissue to therapeutic radiation","volume":"1","author":"Emami","year":"2013","journal-title":"Rep. Radiother. Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Pembroke, C., Hudson, E., and Hanna, L. (2015). Management of cancer of the body of. Pract. Clin. Oncol., 360.","DOI":"10.1017\/CBO9781107280250.028"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1111\/j.1754-9485.2012.02405.x","article-title":"Deep inspiration breath hold technique reduces heart dose from radiotherapy for left-sided breast cancer","volume":"56","author":"Hayden","year":"2012","journal-title":"J. Med. Imaging Radiat. Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Zarenezhad, E., Kanaan, M.H.G., Abdollah, S.S., Vakil, M.K., Marzi, M., Mazarzaei, A., and Ghasemian, A. (2023). Metallic Nanoparticles: Their Potential Role in Breast Cancer Immunotherapy via Trained Immunity Provocation. Biomedicines, 11.","DOI":"10.3390\/biomedicines11051245"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"845037","DOI":"10.3389\/fonc.2022.845037","article-title":"Comparison of deep inspiration breath hold versus free breathing in radiotherapy for left sided breast cancer","volume":"12","author":"Lu","year":"2022","journal-title":"Front. Oncol."},{"key":"ref_25","first-page":"39","article-title":"Cardiac death after breast radiotherapy and the QUANTEC cardiac guidelines","volume":"19","author":"Beaton","year":"2019","journal-title":"Clin. Transl. Radiat. Oncol."},{"key":"ref_26","first-page":"1800","article-title":"Dosimetric comparison between three- and four-dimensional computerised tomography radiotherapy for breast cancer","volume":"18","author":"Yan","year":"2019","journal-title":"Oncol. Lett."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/j.ijrobp.2006.12.035","article-title":"Four-week course of radiation for breast cancer using hypofractionated intensity modulated radiation therapy with an incorporated boost","volume":"68","author":"Freedman","year":"2007","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1016\/j.meddos.2013.01.002","article-title":"A comparative analysis of 3D conformal deep inspiratory\u2013breath hold and free-breathing intensity-modulated radiation therapy for left-sided breast cancer","volume":"38","author":"Reardon","year":"2013","journal-title":"Med. Dosim."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1016\/j.canrad.2023.06.027","article-title":"Radiation therapy in the thoracic region: Radio-induced cardiovascular disease, cardiac delineation and sparing, cardiac dose constraints, and cardiac implantable electronic devices","volume":"27","author":"Petit","year":"2023","journal-title":"Cancer\/Radioth\u00e9rapie"},{"key":"ref_30","first-page":"e23568","article-title":"A Dosimetric study comparing 3D-CRT vs. IMRT vs. VMAT in left-sided breast cancer patients after mastectomy at a tertiary care centre in eastern india","volume":"14","author":"Amritt","year":"2022","journal-title":"Cureus"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1159\/000509779","article-title":"Mammary Chain Irradiation in Left-Sided Breast Cancer: Can We Reduce the Risk of Secondary Cancer and Ischaemic Heart Disease with Modern Intensity-Modulated Radiotherapy Techniques?","volume":"16","author":"Figlia","year":"2021","journal-title":"Breast Care"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/15\/24\/5799\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:36:27Z","timestamp":1760132187000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/15\/24\/5799"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,11]]},"references-count":31,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["cancers15245799"],"URL":"https:\/\/doi.org\/10.3390\/cancers15245799","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,11]]}}}