压缩还是屏气？运动缓解技术对肝胆胰恶性肿瘤患者运动、牵引间设置误差和牵引内误差影响的系统性回顾。

IF 4.9 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology Pub Date : 2024-10-10 DOI:10.1016/j.radonc.2024.110581

Amanda Webster , Yemurai Mundora , Catharine H. Clark , Maria A. Hawkins

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引用次数: 0

摘要

背景和目的：减少运动对治疗肝胆（HPB）和胰腺恶性肿瘤至关重要。腹部加压（AC）和屏气（BH）技术旨在最大限度地减少呼吸运动，但它们的应用仍然有限，实践也各不相同。本综述研究了 AC 和 BH 对 HPB 和胰腺患者的运动、设置误差和患者耐受性的影响：本系统性综述采用 PRISMA 和 PICOS 标准，收录了 2015 年 1 月至 2023 年 2 月期间的出版物。符合条件的研究主要针对成人 HPB 和胰腺恶性肿瘤患者的 AC 和 BH 干预。研究终点包括运动、设置误差、分段内误差和患者耐受性。由于研究存在异质性，因此采用了无 Meta 分析的综合方法，并以 5 毫米为阈值评估运动缓解的影响：在40项研究中，14项研究了AC，26项研究了BH，其中20项研究了HPB，13项研究了胰腺，7项研究了混合队列。其中 6 项研究了预处理，22 项研究了分段间/分段内误差，12 项研究了两者。六项 AC 治疗前研究显示移动量大于 5 毫米，四项 BH 和两项 AC 研究报告显示分段间误差大于 5 毫米。压迫研究通常调查弓和腰带，DIBH 是主要的 BH 技术。没有研究对 AC 和 BH 进行比较。技术存在差异，有几项研究没有遵循标准化误差报告。对患者体验和耐受性的报告不足：结论：研究结果表明 AC 可有效减少运动，但其效果可能会有所不同。BH 可以固定运动，但在不同部位的效果可能不一致。综述强调了进行更大规模标准化研究的必要性，并强调了从患者角度考虑定制治疗的重要性。

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A systematic review of the impact of abdominal compression and breath-hold techniques on motion, inter-fraction set-up errors, and intra-fraction errors in patients with hepatobiliary and pancreatic malignancies

Background and purpose

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.

Materials and methods

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.

Results

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.

Conclusion

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.

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来源期刊

Radiotherapy and Oncology 医学-核医学

CiteScore

10.30

自引率

10.50%

发文量

2445

审稿时长

45 days

期刊介绍： Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.