# The UK HeartSpare Study (Stage II): multicentre evaluation of a voluntary breath-hold technique in patients receiving breast radiotherapy

Source: https://onco.cc/key-papers/paper-heartspare-stage-ii-clin-oncol-2017/  
OnCo record `paper-heartspare-stage-ii-clin-oncol-2017` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

In ten UK centres, women having radiotherapy for left breast cancer were taught to hold a deep breath during treatment without any machine to help. Ninety-five per cent had a lower heart dose as a result, and the average heart dose fell from 1.8 to 1.1 Gy.

## Summary

Bartlett and colleagues recruited 101 women in 2014 at 10 UK centres after surgery for early left breast cancer, selected because part of the heart lay inside the 50 per cent dose line on a standard free-breathing plan. Each had a second planning scan in voluntary breath-hold and was treated with the breath-hold plan. Of 93 with primary endpoint data, 88 (95 per cent) achieved a lower mean heart dose. Mean doses for free breathing and breath-hold were 1.8 and 1.1 Gy to the heart and 12.1 and 5.4 Gy to the left anterior descending coronary artery. Daily portal imaging gave population systematic errors of 1.3 to 1.9 mm and random errors of 1.4 to 1.8 mm. Median CT and treatment session times were 21 and 22 minutes.

## Fields

- Kind: Key paper
- Last checked: 2026-10-20
- Tags: precision; radiation
- Journal: Clinical Oncology
- Year: 2017
- DOI: 10.1016/j.clon.2016.11.005
- Authors: Bartlett FR, Donovan EM, McNair HA, et al.
- Findings: 88 of 93 women (95 per cent) achieved a reduction in mean heart dose with voluntary breath-hold.; Mean heart dose 1.8 Gy free breathing against 1.1 Gy breath-hold; left anterior descending artery 12.1 against 5.4 Gy.; Population systematic error 1.3 to 1.9 mm and random error 1.4 to 1.8 mm.
- What it means: Breath-hold for left breast radiotherapy can be delivered without special breathing equipment across ordinary NHS departments, and lowers heart dose in almost everyone selected for it.
- Caveats: A single-arm comparison of two plans in the same women, not a randomised trial of heart outcomes.; Only women with heart inside the 50 per cent isodose on the free-breathing plan were included.

## Sources

- Clinical Oncology 2017: https://doi.org/10.1016/j.clon.2016.11.005
- PubMed 27890346: https://pubmed.ncbi.nlm.nih.gov/27890346/

## Connected records

- cancers: [HER2-positive breast cancer](https://onco.cc/cancers/breast-her2-positive/), [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/), [Triple-negative breast cancer (TNBC)](https://onco.cc/cancers/tnbc/)
- fronts: [Radiation Therapy](https://onco.cc/fronts/radiation/)
- technologies: [Respiratory motion management (4D-CT, gating, breath-hold, tracking)](https://onco.cc/technologies/respiratory-motion-management/), [Surface-guided radiotherapy (SGRT)](https://onco.cc/technologies/surface-guided-radiotherapy/)
- terms: [Deep inspiration breath-hold (DIBH)](https://onco.cc/terms/deep-inspiration-breath-hold/)
- journals: [Clinical oncology](https://onco.cc/journals/clinical-oncology-rcr/)

---
JSON: https://onco.cc/api/v1/entities/paper-heartspare-stage-ii-clin-oncol-2017.json