Pollock Sean, Keall Robyn, Keall Paul
Radiation Physics Laboratory, University of Sydney, Sydney 2050, Australia.
Central School of Medicine, University of Sydney, Sydney 2050, Australia and Hammond Care, Palliative Care and Supportive Care Service, Greenwich 2065, Australia.
Med Phys. 2015 Sep;42(9):5490-509. doi: 10.1118/1.4928488.
The advent of image-guided radiation therapy has led to dramatic improvements in the accuracy of treatment delivery in radiotherapy. Such advancements have highlighted the deleterious impact tumor motion can have on both image quality and radiation treatment delivery. One approach to reducing tumor motion irregularities is the use of breathing guidance systems during imaging and treatment. These systems aim to facilitate regular respiratory motion which in turn improves image quality and radiation treatment accuracy. A review of such research has yet to be performed; it was therefore their aim to perform a systematic review of breathing guidance interventions within the fields of radiation oncology and radiology.
From August 1-14, 2014, the following online databases were searched: Medline, Embase, PubMed, and Web of Science. Results of these searches were filtered in accordance to a set of eligibility criteria. The search, filtration, and analysis of articles were conducted in accordance with preferred reporting items for systematic reviews and meta-analyses. Reference lists of included articles, and repeat authors of included articles, were hand-searched.
The systematic search yielded a total of 480 articles, which were filtered down to 27 relevant articles in accordance to the eligibility criteria. These 27 articles detailed the intervention of breathing guidance strategies in controlled studies assessing its impact on such outcomes as breathing regularity, image quality, target coverage, and treatment margins, recruiting either healthy adult volunteers or patients with thoracic or abdominal lesions. In 21/27 studies, significant (p < 0.05) improvements from the use of breathing guidance were observed.
There is a trend toward the number of breathing guidance studies increasing with time, indicating a growing clinical interest. The results found here indicate that further clinical studies are warranted that quantify the clinical impact of breathing guidance, along with the health technology assessment to determine the advantages and disadvantages of breathing guidance.
图像引导放射治疗的出现显著提高了放射治疗中治疗实施的准确性。这些进展凸显了肿瘤运动对图像质量和放射治疗实施可能产生的有害影响。减少肿瘤运动不规则性的一种方法是在成像和治疗过程中使用呼吸引导系统。这些系统旨在促进规律的呼吸运动，进而提高图像质量和放射治疗准确性。尚未对这类研究进行综述；因此，他们的目的是对放射肿瘤学和放射学领域内的呼吸引导干预措施进行系统综述。
2014年8月1日至14日，检索了以下在线数据库：医学索引数据库（Medline）、荷兰医学文摘数据库（Embase）、美国国立医学图书馆生物医学数据库（PubMed）和科学引文索引数据库（Web of Science）。这些检索结果根据一组纳入标准进行筛选。文章的检索、筛选和分析按照系统综述和荟萃分析的首选报告项目进行。对纳入文章的参考文献列表以及纳入文章的重复作者进行了手工检索。
系统检索共获得480篇文章，根据纳入标准筛选后，最终得到27篇相关文章。这27篇文章详细介绍了在对照研究中呼吸引导策略的干预情况，这些研究评估了其对呼吸规律性、图像质量、靶区覆盖范围和治疗边界等结果的影响，研究对象为健康成年志愿者或患有胸部或腹部病变的患者。在27项研究中的21项中，观察到使用呼吸引导后有显著（p < 0.05）改善。
随着时间的推移，呼吸引导研究的数量有增加的趋势，表明临床兴趣日益浓厚。此处发现的结果表明，有必要开展进一步的临床研究，以量化呼吸引导的临床影响，并进行卫生技术评估，以确定呼吸引导的优缺点。
