摘 要：在乳腺癌放射治疗中，心脏及其亚结构暴露于放射环境是引发远期心血管疾病的重要风险因素之一，尤其在左侧乳腺癌患者中表现更为突出。深吸气屏气（DIBH）技术主要是通过让病人深吸气后屏气，从而使心脏远离靶区，来达到降低心脏辐射剂量的目的。本文系统综述了DIBH技术的原理、剂量学优势及其与不同放射治疗技术［三维适形放射治疗（3DCRT）、调强适形放射治疗（IMRT）、容积弧形调强放射治疗（VMAT）、质子治疗技术］结合的应用效果。研究发现，DIBH技术可显著降低平均心脏剂量（MHD）及左前降支冠状动脉（LAD）、左心室（LV）等亚结构剂量，其中DIBH联合3DCRT或质子治疗技术的心脏保护效果最优，而IMRT与VMAT在结合DIBH时，需要进一步考虑靶区剂量均匀性与心脏剂量，从而选择最优的方式。此外，针对心脏亚结构剂量与心血管事件风险之间的相关性，需要结合解剖特征、生物标志物及剂量参数等相关因素，来构建个体化风险预测模型。而在未来，我们应该聚焦于技术的优化、患者筛选及多模态影像引导，通过这些措施，最大程度地利用DIBH技术，使其最大限度地减少放射治疗相关心脏毒性。
关键词：乳腺癌；放射治疗；深吸气屏气技术；心脏保护；剂量学
中图分类号：R737.9                  文献标志码：A                      DOI：10.3969/j.issn.1007-7146.2026.01.002

Abstract: In breast cancer radiotherapy, exposure of the heart and its substructures to radiation is one of the important risk factors for long-term cardiovascular diseases, which is particularly prominent in patients with left-sided breast cancer. The deep inspiration breath hold (DIBH) technique is an effective method to reduce cardiac radiation dose by having the patient take a deep breath and hold it, thereby moving the heart away from the target area. This article systematically reviews the principles, dosimetric advantages of the DIBH technique, and its application effects when combined with different radiotherapy techniques involving three-dimensional conformal radiation therapy (3DCRT), intensity modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT) and proton therapy technology. Studies have shown that the DIBH technique can significantly reduce the mean heart dose (MHD) and the doses to substructures such as the left anterior descending artery (LAD) and left ventricle (LV). Among them, it is found that DIBH combined with 3DCRT or proton therapy technology has the best cardioprotective effect. While when combining IMRT and VMAT with DIBH, further consideration of target dose uniformity and cardiac dose is needed to select the optimal method. In addition, regarding the correlation between cardiac substructure doses and the risk of cardiovascular events, it is necessary to combine relevant factors such as anatomical characteristics, biomarkers, and dose parameters to construct an individualized risk prediction model. In the future, we should focus on technical optimization, patient selection, and multimodal image guidance. Through these measures, maximizing the use of the DIBH technique will enable us to minimize radiotherapy-related cardiac toxicity.
Key words: breast cancer; radiation therapy; deep inspiration breath hold; cardiac protection; dosimetry
（Acta Laser Biology Sinica, 2026, 35(1): 010-018）