Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK; Department of Medical Physics and Biomedical Engineering, University College London, London, UK.
Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK.
Radiother Oncol. 2024 Dec;201:110581. doi: 10.1016/j.radonc.2024.110581. Epub 2024 Oct 10.
Reducing motion is vital when radiotherapy is used to treat patients with hepatobiliary (HPB) and pancreatic malignancies. Abdominal compression (AC) and breath-hold (BH) techniques aim to minimise respiratory motion, yet their adoption remains limited, and practices vary. This review examines the impact of AC and BH on motion, set-up errors, and patient tolerability in HPB and pancreatic patients.
This systematic review, conducted using PRISMA and PICOS criteria, includes publications from January 2015 to February 2023. Eligible studies focused on AC and BH interventions in adults with HPB and pancreatic malignancies. Endpoints examined motion, set-up errors, intra-fraction errors, and patient tolerability. Due to study heterogeneity, Synthesis Without Meta-Analysis was used, and a 5 mm threshold assessed the impact of motion mitigation.
In forty studies, 14 explored AC and 26 BH, with 20 on HPB, 13 on pancreatic, and 7 on mixed cohorts. Six studied pre-treatment, 22 inter/intra-fraction errors, and 12 both. Six AC pre-treatment studies showed > 5 mm motion, and 4 BH and 2 AC studies reported > 5 mm inter-fraction errors. Compression studies commonly investigated the arch and belt, and DIBH was the predominant BH technique. No studies compared AC and BH. There was variation in the techniques, and several studies did not follow standardised error reporting. Patient experience and tolerability were under-reported.
The results indicate that AC effectively reduces motion, but its effectiveness may vary between patients. BH can immobilise motion; however, it can be inconsistent between fractions. The review underscores the need for larger, standardised studies and emphasizes the importance of considering the patient's perspective for tailored treatments.
在使用放射疗法治疗肝胆（HPB）和胰腺恶性肿瘤患者时，减少运动至关重要。腹部压缩（AC）和屏气（BH）技术旨在最大限度地减少呼吸运动，但它们的采用仍然有限，且实践各不相同。本综述检查了 AC 和 BH 对 HPB 和胰腺患者运动、摆位误差和患者耐受性的影响。
本系统综述使用 PRISMA 和 PICOS 标准进行，包括 2015 年 1 月至 2023 年 2 月发表的文献。合格的研究集中在 HPB 和胰腺恶性肿瘤成人患者的 AC 和 BH 干预措施上。检查的终点包括运动、摆位误差、分次内误差和患者耐受性。由于研究异质性，采用无荟萃分析的综合方法，使用 5 毫米阈值评估运动缓解的影响。
在四十项研究中，有 14 项研究 AC，26 项研究 BH，其中 20 项研究 HPB，13 项研究胰腺，7 项研究混合队列。有 6 项研究预处理，22 项研究分次内/间误差，12 项研究两者都有。6 项 AC 预处理研究显示运动超过 5 毫米，4 项 BH 和 2 项 AC 研究报告分次间误差超过 5 毫米。压缩研究通常研究拱和带，DIBH 是主要的 BH 技术。没有研究比较 AC 和 BH。技术存在差异，并且一些研究没有按照标准报告错误。患者体验和耐受性报告不足。
结果表明，AC 可有效减少运动，但对不同患者的效果可能不同。BH 可以固定运动，但在分次之间可能不一致。本综述强调了需要进行更大、标准化的研究，并强调了考虑患者视角进行个体化治疗的重要性。
