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

Journal

MEDICINE
Volume 100, Issue 20, Pages -

Publisher

LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/MD.0000000000026000

Keywords

breast cancer; deep inspiration breath hold; meta-analysis; prone position; radiotherapy; supine position

Funding

  1. First batch of Yiwu Science and Technology Project in 2019 [19-3-03]

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This meta-analysis evaluates the difference of sparing organs at risk in different positions and breathing patterns for breast cancer patients receiving postoperative radiotherapy. Prone position with free breathing can effectively reduce OAR doses without compromising target coverage in comparison to supine position with free breathing. Additionally, prone position with deep inspiration breath hold might be the most promising way for breast cancer patients to undergo radiotherapy.
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 similar to - 0.36, P .00001. LADCA dose, SMD = - 0.58, 95% CI - 0.85 similar to - 0.31, P .0001. ILL dose, SMD = - 2.84, 95% CI - 3.2 similar to - 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 similar to 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.

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