nucВестник НЯЦ РКNNC RK Bulletin1729-75161729-7885Национальный ядерный центр Республики Казахстан10.52676/1729-7885-2026-1-169-176nuc-999Research ArticleСтатьиВЛИЯНИЕ ДЫХАТЕЛЬНОГО ГЕЙТИНГА НА ДОЗОВОЕ РАСПРЕДЕЛЕНИЕ И ЗАЩИТУ КРИТИЧЕСКИХ ОРГАНОВ ПРИ ЛУЧЕВОЙ ТЕРАПИИ РАКА МОЛОЧНОЙ ЖЕЛЕЗЫIMPACT OF RESPIRATORY GATING ON DOSE DISTRIBUTION AND PROTECTION OF CRITICAL ORGANS IN RADIOTHERAPY FOR BREAST CANCERhttps://orcid.org/0009-0005-8621-9381АлибековаА. Д.AlibekovaA. D.

Медицинский физик

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Semey

aigul-aiko@mail.ruhttps://orcid.org/0000-0002-4553-356XКенжинаЛ. Б.KenzhinaL. B.

Советник по науке

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Semey

laurakenzhina@yandex.ruhttps://orcid.org/0009-0009-4893-9264ИдиновМ. Т.IdinovM. T.

Главный инженер

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Semey

idinov_medet@list.ruhttps://orcid.org/0009-0003-0004-8354АтантаеваБ. Ж.AtantayevaB. Zh.

Заместитель директора

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bayan_atantaeva@mail.ruhttps://orcid.org/0009-0009-4069-889XАйткалиевС. М.AitkaliyevS. M.

Заведующий отделением медицинских физиков

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seka_asm@mail.ruhttps://orcid.org/0009-0005-3700-9812МергенбаеваА. Д.MergenbayevaA. D.

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ainur.mergenbayeva@mail.ruhttps://orcid.org/0000-0002-8148-6617АлдынгуровД. К.AldyngurovD. K.

Хирург-онколог

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daniyarishe@mail.ruhttps://orcid.org/0000-0003-0379-5315ТанатаровС. З.TanatarovS. Z.

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sayat68@mail.ruКГП «Центр ядерной медицины и онкологии» УЗ области АбайКазахстан“Center of Nuclear Medicine and Oncology” of Abay Regional Health DepartmentKazakhstan20262504202601169176Copyright © Алибекова А.Д., Кенжина Л.Б., Идинов М.Т., Атантаева Б.Ж., Айткалиев С.М., Мергенбаева А.Д., Алдынгуров Д.К., Танатаров С.З., 20262026Алибекова А.Д., Кенжина Л.Б., Идинов М.Т., Атантаева Б.Ж., Айткалиев С.М., Мергенбаева А.Д., Алдынгуров Д.К., Танатаров С.З.Alibekova A.D., Kenzhina L.B., Idinov M.T., Atantayeva B.Z., Aitkaliyev S.M., Mergenbayeva A.D., Aldyngurov D.K., Tanatarov S.Z.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journals.nnc.kz/jour/article/view/999

Настоящая работа посвящена дозиметрической оценке эффективности техники глубокого вдоха на задержке дыхания (DIBH) как метода кардиопротекции при адъювантной лучевой терапии рака левой молочной железы. Основной целью исследования являлось сравнение дозиметрических параметров лучевой нагрузки на сердце в режиме DIBH с традиционным режимом свободного дыхания (FB), при условии сохранения адекватного покрытия планируемого целевого объема (PTV). Для достижения этой цели был проведен ретроспективный дозиметрический анализ планов трёхмерной конформной лучевой терапии (3D-CRT) для 10 пациенток, где сравнивались ключевые дозовые показатели для PTV, легких, сердца, пищевода, спинного мозга и контрлатеральной молочной железы. Результаты анализа убедительно продемонстрировали, что, несмотря на дозиметрическую эквивалентность по покрытию PTV и защите легочной паренхимы (V20Гр), техника DIBH обеспечивает выраженный защитный эффект в отношении кардиальных структур. В режиме DIBH зафиксировано статистически значимое снижение средней дозы на сердце (Dmean) более чем на 50% – с 33,16±3,79 Гр до 15,49±4,50 Гр (p < 0,001). Наиболее критичное снижение дозовой экспозиции достигнуто для левой передней нисходящей артерии (LAD). Данный щадящий эффект объясняется физиологическим смещением сердца в каудальном направлении во время глубокого вдоха, что эффективно удаляет его от поля облучения. Таким образом, техника DIBH обеспечивает превосходную кардиопротекцию, значительно минимизируя долгосрочные кардиоваскулярные риски (особенно связанные с LAD) без ущерба для онкологической адекватности лечения, подтверждая необходимость ее внедрения в качестве золотого стандарта в региональные клинические протоколы.

This study is dedicated to the dosimetric evaluation of the Deep Inspiration Breath Hold (DIBH) technique as a cardioprotective method during adjuvant radiotherapy for left-sided breast cancer. The primary objective of the research was to compare the dosimetric parameters of radiation exposure to the heart in the DIBH mode with those obtained in the conventional Free Breathing (FB) mode, while maintaining adequate coverage of the Planning Target Volume (PTV). To achieve this objective, a retrospective dosimetric analysis of three-dimensional conformal radiotherapy (3D-CRT) plans for 10 patients was performed. Key dose–volume metrics for the PTV, lungs, heart, esophagus, spinal cord, and contralateral breast were assessed. The results demonstrated that, despite the dosimetric equivalence in PTV coverage and protection of lung parenchyma (V20 Gy), the DIBH technique provides a pronounced protective effect on cardiac structures. In the DIBH mode, a statistically significant reduction of more than 50% in the mean heart dose (Dmean) was observed – from 33,16±3,79 Gy to 15,49±4,50 Gy (p  0,001). The most substantial reduction in radiation exposure was recorded for the left anterior descending coronary artery (LAD). This sparing effect is explained by the physiological caudal displacement of the heart during deep inspiration, effectively increasing the distance between the heart and the irradiation field. Thus, the DIBH technique ensures excellent cardioprotection, significantly reducing long-term cardiovascular risks – particularly those associated with LAD exposure – without compromising the oncological adequacy of treatment. These findings confirm the necessity of implementing DIBH as a gold standard in regional clinical radiotherapy protocols.

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The authors declare that there are no conflicts of interest present.