目的:系统回顾所有剂量学研究,研究深吸气屏气(DIBH)与自由呼吸(FB)相比,纵隔淋巴瘤患者接受质子治疗与IMRT(调强放疗)相比的影响-DIBH。
方法:我们根据系统评价和Meta分析的首选报告项目指南,使用PubMed数据库进行了系统评价,以确定纵隔淋巴瘤患者的质子-FB和/或质子-DIBH与IMRT-DIBH的剂量学比较研究。参数包括平均心脏(MHD),肺(MLD),和乳房(MBD)剂量,在其他参数中。病例报告被排除。比较者之间平均剂量>IGy的绝对差异被认为是有临床意义的。
结果:截至2021年4月,有8项研究符合这些标准(n=8),以下比较:质子-FB与IMRT-DIBH(n=5),质子-DIBH与质子-FB(n=5),和质子-DIBH与IMRT-DIBH(n=8)。在5项研究中比较质子-FB和IMRT-DIBH时,在2项研究中,质子-FB降低了MHD,在2项研究中相似(<1Gy差异),并在1项研究中增加。另一方面,在3和4项研究中,MLD和MBD被质子-FB还原,分别。当比较质子-DIBH和质子-FB时,在4和3项研究中,MHD和MLD被质子DIBH还原,分别,而MBD保持相似。与8项研究中的IMRT-DIBH相比,质子-DIBH在7项研究中降低了MHD,在1项研究中相似。此外,在8和6项研究中,分别用质子-DIBH还原了MLD和MBD。质子-FB和质子-DIBH的积分剂量相似,两者均显著低于IMRT-DIBH。
结论:心脏会计,肺,乳房,和积分剂量,质子治疗(FB或DIBH)优于IMRT-DIBH。与质子-FB相比,质子-DIBH可以进一步降低肺部和心脏的剂量,根据纵隔的疾病位置,以及器官保护和目标覆盖优先事项。
To systematically
review all dosimetric studies investigating the impact of deep inspiration breath hold (DIBH) compared with free breathing (FB) in mediastinal lymphoma patients treated with proton therapy as compared to IMRT (intensity-modulated radiation therapy)-DIBH.
We conducted a systematic
review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline using the PubMed database to identify studies of mediastinal lymphoma patients with dosimetric comparisons of proton-FB and/or
proton-DIBH with IMRT-DIBH. Parameters included mean heart (MHD), lung (MLD), and breast (MBD) doses, among other parameters. Case reports were excluded. Absolute differences in mean doses > 1 Gy between comparators were considered to be clinically meaningful.
As of April 2021, eight studies fit these criteria (n = 8), with the following comparisons: proton-FB vs IMRT-DIBH (n = 5),
proton-DIBH vs
proton-FB (n = 5), and
proton-DIBH vs IMRT-DIBH (n = 8). When comparing proton-FB with IMRT-DIBH in 5 studies, MHD was reduced with proton-FB in 2 studies, was similar (<1 Gy difference) in 2 studies, and increased in 1 study. On the other hand, MLD and MBD were reduced with proton-FB in 3 and 4 studies, respectively. When comparing
proton-DIBH with
proton-FB, MHD and MLD were reduced with
proton DIBH in 4 and 3 studies, respectively, while MBD remained similar. Compared with IMRT-DIBH in 8 studies, proton-DIBH reduced the MHD in 7 studies and was similar in 1 study. Furthermore, MLD and MBD were reduced with proton-DIBH in 8 and 6 studies respectively. Integral dose was similar between proton-FB and proton-DIBH, and both were substantially lower than IMRT-DIBH.
Accounting for heart, lung, breast, and integral dose, proton therapy (FB or DIBH) was superior to IMRT-DIBH. Proton-DIBH can lower dose to the lungs and heart even further compared with proton-FB, depending on disease location in the mediastinum, and organ-sparing and target coverage priorities.