Lu Yongkai, Yang Di, Zhang Xiaowei, Teng Yonggang, Yuan Wei, Zhang Yuemei, He Ruixin, Tang Fengwen, Pang Jie, Han Bo, Chen Ruijuan, Li Yi
Department of Radiation Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Department of Radiation Oncology, Shaanxi Provincial Tumor Hospital, Affiliated Hospital of Xi'an Jiaotong University Health Science Center, Xi'an, China.
Front Oncol. 2022 Apr 21;12:845037. doi: 10.3389/fonc.2022.845037. eCollection 2022.
Modern breast cancer techniques, such as the deep inspiration breath-hold (DIBH) technique has been applied for left-sided breast cancer. Whether the DIBH regimen is the optimal solution for left-sided breast cancer remains unclear. This meta-analysis aims to elucidate the differences of DIBH and free-breathing (FB) for patients receiving radiotherapy for left-sided breast cancer and provide a practical reference for clinical practice.
Relevant research available on PubMed, Embase, Cochrane Library, and the Web of Science published before November 30, 2021 was independently and systematically examined by two investigators. Data were extracted from eligible studies for assessing their qualities and calculating the standardized mean difference (SMD) and 95% confidence intervals (CIs) using Review Manager software 5.4 (RevMan 5.4).
Forty-one studies with a total of 3599 left-sided breast cancer patients were included in the meta-analysis. Compared with FB, DIBH reduced heart dose ( , , V30, V10, V5), left anterior descending branch (LAD) dose ( , ), ipsilateral lung dose ( , V20, V10, V5), and heart volume significantly. Lung volume increased greatly, and a statistically significant difference. For contralateral breast mean dose, DIBH has no obvious advantage over FB. The funnel plot suggested this study has no significant publication bias.
Although DIBH has no obvious advantage over FB in contralateral breast mean dose, it can significantly reduce heart dose, LAD dose, ipsilateral lung dose, and heart volume. Conversely, it can remarkably increase the ipsilateral lung volume. This study suggests that soon DIBH could be more widely utilized in clinical practice because of its excellent dosimetric performance.
现代乳腺癌技术，如深吸气屏气（DIBH）技术已应用于左侧乳腺癌。DIBH方案是否是左侧乳腺癌的最佳解决方案仍不清楚。本荟萃分析旨在阐明接受左侧乳腺癌放疗的患者采用DIBH和自由呼吸（FB）的差异，并为临床实践提供实际参考。
两名研究者独立且系统地检索了2021年11月30日前发表在PubMed、Embase、Cochrane图书馆和科学网的相关研究。从符合条件的研究中提取数据，以评估其质量，并使用Review Manager软件5.4（RevMan 5.4）计算标准化均值差（SMD）和95%置信区间（CI）。
荟萃分析纳入了41项研究，共3599例左侧乳腺癌患者。与FB相比，DIBH显著降低了心脏剂量（ 、 、V30、V10、V5）、左前降支（LAD）剂量（ 、 ）、同侧肺剂量（ 、V20、V10、V5）和心脏体积。肺体积显著增加，且差异有统计学意义。对于对侧乳腺平均剂量，DIBH与FB相比无明显优势。漏斗图表明本研究无明显发表偏倚。
尽管DIBH在对侧乳腺平均剂量方面与FB相比无明显优势，但它可显著降低心脏剂量、LAD剂量、同侧肺剂量和心脏体积。相反，它可显著增加同侧肺体积。本研究表明，由于其出色的剂量学性能，DIBH可能很快在临床实践中得到更广泛的应用。
