Prone position versus supine position in postoperative radiotherapy for breast cancer: A meta-analysis.

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Abstrakt

Tytuł:: Prone position versus supine position in postoperative radiotherapy for breast cancer: A meta-analysis.
Autorzy:: Lai J; Department of Radiation Oncology, Yiwu Central Hospital, The Affiliated Yiwu Hospital of Wenzhou Medical University, Yiwu, Zhejiang.
Zhong F; Department of oncology, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, Jiangxi.
Deng J; Department of oncology, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, Jiangxi.
Hu S; Department of General Medicine, Yiwu Central Hospital, The Affiliated Yiwu Hospital of Wenzhou Medical University, Yiwu, Zhejiang.
Shen R; Department of Second Institute of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, P.R. China.
Luo H; Department of oncology, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, Jiangxi.
Luo Y; Department of Radiation Oncology, Yiwu Central Hospital, The Affiliated Yiwu Hospital of Wenzhou Medical University, Yiwu, Zhejiang.
Źródło:: Medicine [Medicine (Baltimore)] 2021 May 21; Vol. 100 (20), pp. e26000.
Typ publikacji:: Comparative Study; Journal Article; Meta-Analysis
Język:: English
Imprint Name(s):: Original Publication: Hagerstown, Md : Lippincott Williams & Wilkins
MeSH Terms:: Breast Neoplasms/*therapy
Organ Sparing Treatments/*methods
Organs at Risk/*radiation effects
Patient Positioning/*methods
Radiation Injuries/*prevention & control
Coronary Vessels/radiation effects ; Female ; Heart/radiation effects ; Humans ; Lung/radiation effects ; Mastectomy ; Prone Position ; Radiation Injuries/etiology ; Radiometry/statistics & numerical data ; Radiotherapy Dosage ; Radiotherapy, Adjuvant/adverse effects ; Radiotherapy, Adjuvant/methods ; Supine Position
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Grant Information:: 19-3-03 The First batch of Yiwu Science and Technology Project in 2019
Entry Date(s):: Date Created: 20210520 Date Completed: 20210525 Latest Revision: 20230103
Update Code:: 20240104
PubMed Central ID:: PMC8136988
DOI:: 10.1097/MD.0000000000026000
PMID:: 34011096
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Background: This meta-analysis evaluates the difference of sparing organs at risk (OAR) in different position (Prone position and Supine position) with different breathing patterns (Free breathing, FB/Deep inspiration breath hold, DIBH) for breast cancer patients receiving postoperative radiotherapy and provides a useful reference for clinical practice.
Method: The relevant controlled trials of prone position versus supine position in postoperative radiotherapy for breast cancer were retrieved from the sources of PubMed, Cochrane Library, Embase, Web of Science and ClinicalTrails.gov. The principal outcome of interest was OAR doses (heart dose, left anterior descending coronary artery dose and ipsilateral lung dose) and target coverage. We mainly compared the effects of P-FB (Prone position FB) and S-FB (Supine position FB) and discussed the effects of DIBH combined with different positions on OAR dose in postoperative radiotherapy. We calculated summary standardized mean difference (SMD) and 95% confidence intervals (CI). The meta-analysis was performed using RevMan 5.4 software.
Results: The analysis included 751 patients from 19 observational studies. Compared with the S-FB, the P-FB can have lower heart dose, left anterior descending coronary artery (LADCA) dose, and ipsilateral lung dose (ILL) more effectively, and the difference was statistically significant (heart dose, SMD = - 0.51, 95% CI - 0.66 ∼ - 0.36, P < .00001. LADCA dose, SMD = - 0.58, 95% CI - 0.85 ∼ - 0.31, P < .0001. ILL dose, SMD = - 2.84, 95% CI - 3.2 ∼ - 2.48, P < .00001). And there was no significant difference in target coverage between the S-FB and P-FB groups (SMD = - 0.1, 95% CI - 0.57 ∼ 0.36, P = .66). Moreover, through descriptive analysis, we found that P-DIBH (Prone position DIBH) has better sparing OAR than P-FB and S-DIBH (Supine position DIBH).
Conclusion: By this meta-analysis, compared with the S-FB we found that implementation of P-FB in postoperative radiotherapy for breast cancer can reduce irradiation of heart dose, LADCA dose and ILL dose, without compromising mean dose of target coverage. Moreover, P-DIBH might become the most promising way for breast cancer patients to undergo radiotherapy.
(Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

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