## 3 Results
### Other Factors  
\(\bullet\) IMRT, VMAT, proton techniques vs. DIBH  
[PERSON] et al. reported that the efficacy of IMRT in synergy with DIBH is somewhat limited by the potential impact of respiratory motion [38]. In contrast, VMAT according to [PERSON] et al. and [PERSON] et al. uses its rotational delivery and adaptive modulation capabilities to harmonize with DIBH, showing better target coverage and reduced irradiation of healthy tissues during specific respiratory phases [6; 20]. Proton therapy, discussed by [PERSON] and [PERSON] et al., is distinguished by its inherent physical properties, particularly the Bragg peak, which allows for precise dose deposition, minimizing the integral dose to surrounding tissues [39; 40]. According to [PERSON] et al., proton therapy shows promise in reducing total dose exposure; however, its compatibility with DIBH and management of respiratory motion present challenges that require further research and optimization to maximize its benefits in combination with DIBH [39]. The choice between intensity-modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT), and proton therapy in combination with deep breath-holding (DIBH) reveals clear advantages and differences between the above techniques. IMRT highlighted in studies by authors such as [PERSON], [PERSON], and [PERSON] \begin{table}
\begin{tabular}{c c c c c} \hline \hline
**Reference** & **Study Type** & **N** & **Year** & **Risk Factors** \\ \hline [PERSON] et al. [5] & Cross-sectional study & 130 & 2021 & Age, cardiovascular risk factors, and smoking \\ \hline [PERSON] et al. [34] & Systematic review & & 2020 & Prior cardiovascular disease, diabetes, COPD, smoking history, and high BMI \\ \hline [PERSON] et al. [33] & Prospective cohort study & 210 & 2020 & The evaluated parameters included smoking behavior, history of diabetes mellitus, antihypertensive therapy, and family history of cardiovascular disease. If available, CRP and cholesterol levels (LDL, HDL, triglycerides) were reported. \\ \hline [PERSON] et al. [35] & Systematic review & & 2019 & History of ischemic heart disease, diabetes, chronic obstructive pulmonary disease, smoking, body mass index \(\geq\) 30 kg/m\({}^{2}\), arterial hypertension, dyslipidemia \\ \hline [PERSON] et al. [16] & Prospective cohort study & 89 & 2019 & Age; individual coronary heart disease mortality risks can be estimated by the SCORE prediction formula. SCORE takes into account the following individual risk factors: cholesterol level, systolic blood pressure, and smoking. \\ \hline [PERSON] et al. [32] & Prospective cohort study & 432 & 2023 & Age, diabetes, hypertension, smoking \\ \hline [PERSON] et al. [36] & Prospective cohort study & 103 & 2018 & Age, body mass index, and smoking status, in addition to medical co-morbidities CHF, prior chest surgery, prior lung disease, or presence of simultaneous psychiatric conditions \\ \hline [PERSON] [PERSON] et al. [37] & Cross-sectional study & 183 & 2019 & Prior cardiovascular diseases, diabetes, hypertension, smoking history, and BMI \\ \hline [PERSON] [PERSON] et al. [21] & Retrospective dosimetric study & 20 & 2019 & Age, BMI \\ \hline \hline \end{tabular} N—number of patients in the trial, COPD—Chronic Obstructive Pulmonary Disease, BMI—Body Mass Index, CRP—C-Reactive Protein, LDL—Low-density lipoprotein, HDL—High-density lipoprotein, CHF—Congestive Heart Failure.  
\end{table} 
Table 1: Risk factors affecting the occurrence of late cardiovascular sequelae after DIBH. et al. showed significant compliance with tumor volumes while sparing critical organs due to its ability to modulate beam intensity (conformal dose distribution) [8; 38; 41]. The ability to adapt to motion dynamics is a significant advantage over IMRT in combination with DIBH, as it minimizes uncertainties associated with breathing-induced organ motion. * Use of CPAP as an adjunct to DIBH Results from the study by [PERSON] et al.