乳腺癌保乳术后俯卧位与仰卧位放疗剂量比较的Meta分析

    Dosimetric Comparation between Two Positions (Prone Versus Supine) for Breast-Conserving Postoperative Radiotherapy: A Meta-Analysis

    • 摘要: 目的 探讨乳腺癌保乳术后放疗采用俯卧位与仰卧位靶区和危及器官的剂量差异,为临床实践提供证据。 方法 制定严格的纳入和排除标准,计算机检索 Cochrane 图书馆(2014第1期)、PubMed、FMJS、EMBASE、CHKD、CNKI、VIP和Wanfang 数据库,查找有关乳腺癌保乳术后俯卧位与仰卧位靶区和危及器官剂量对比的临床研究,检索时限均为建库至2014年7月25日。统计学处理采用RevMan5.2软件计算标准化均数差进行分析。 结果 经评价最终纳入17个研究,包含542例乳腺癌保乳术后放疗患者。Meta分析结果显示: ①乳腺癌保乳术后患者采用俯卧位放疗患侧肺标准化均数差=-4.36,95%可信区间(-5.41,-3.31),P<0.000 01和心脏标准化均数差=-0.24,95%可信区间(-0.4,-0.09),P=0.002受照剂量低于仰卧位。②靶区剂量均匀性俯卧位明显好于仰卧位标准化均数差=0.42,95%可信区间(0.24,0.60),P<0.001;但靶区剂量覆盖范围在两种体位间无明显差异标准化均数差=-0.18,95%可信区间(-0.39,0.04),P=0.11。③两种体位间腋窝淋巴结Ⅰ区标准化均数差=-7.49,95%可信区间(-15.24,0.26),P=0.06和Ⅱ区标准化均数差=-5.38,95%可信区间(-11.31,0.56),P=0.08的剂量覆盖范围无明显差异,但Ⅲ区剂量覆盖范围俯卧位明显低于仰卧位标准化均数差=-1.14,95%可信区间(-1.61,0.67),P<0.001。 结论 与仰卧位相比,乳腺癌保乳术后俯卧位放疗可降低心脏和患侧肺的受照剂量,改善靶区剂量均匀性,但对腋窝淋巴结区剂量覆盖范围明显不足。

       

      Abstract: Objective To investigate the dosimetric differences between prone position and supine position for breast cancer radiotherapy after breast-conserving surgery. Method Strict inclusion and exclusion criteria was drew up. We searched the databases including the Cochrane Library (Issue 1, 2014), PubMed, FMJS, EMBASE, CHKD, CNKI, WanFang Data and VIP from inception to July 25, 2014. Dosimetric comparisons of targets and organs at risk for breast-conserving postoperation radiotherapy between two positions were included. Standardized mean difference and 95% confidence interval were computed by using statistical software RevMan5.2. Results 17 trials involving 542 patients were included. Meta-analysis of these trials showed that: ①Radiation exposure of ipsilateral lung SMD=-4.36, 95%CI (-5.41,-3.31), P<0.000 01 and heart SMD=-0.24, 95%CI(-0.4,-0.09), P=0.002 in patients after breast-conserving surgery were dramatically lower in the prone group than supine one. ②Target homogeneity was significantly better in the prone position SMD=0.42, 95%CI(0.24,0.60), P<0.001, but the planning target volume coverage did not differ between the two positionsSMD=-0.18,95%CI(-0.39,0.04), P=0.11. ③There were no differences in target coverage of axillary nodal regions(ANL)for levels I SMD=-7.49, 95%CI(-15.24,0.26), P=0.06 and ⅡSMD=-5.38,95%CI(-11.31,0.56), P=0.08 between the prone and the supine positions, while the target coverage of ALN level Ⅲ was dramatically inadequate in the prone position (SMD=-1.14, 95%CI(-1.61, -0.67), P<0.001). Conclusions The use of prone radiotherapy resulted in the improved target homogeneity and greater sparing of ipsilateral lung and heart than supine position in patients after breast-conserving surgery. Unfortunately, prone radiotherapy provided inadequate axillary nodal coverage.

       

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