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乳腺癌改良根治术后容积调强弧形治疗与调强放疗剂量比较的Meta分析
高艳, 钟鹤立, 李壮玲, 张光伟, 李隆兴, 史亚滨, 李先明
深圳市人民医院(暨南大学第二临床医学院,南方科技大学第一附属医院)肿瘤放疗科 518020
Meta-analysis of dosimetric comparison between volumetric-modulated arc therapy and intensity-modulated radiotherapy for breast cancer after modified radical mastectomy
Gao Yan, Zhong Heli, Li Zhuangling, Zhang Guangwei, Li Longxing, Shi Yabin, Li Xianming
Department of Radiation Oncology, Shenzhen People's Hospital (Second Clinical Medical College, Ji'nan University, First Affiliated Hospital, Southern University of Science and Technology), Shenzhen 518020, China
Abstract：Objective To compare the dosimetric differences between volumetric-modulated arc therapy (VMAT) and intensity-modulated radiation therapy (IMRT) on planning target volume (PTV) and organ-at-risk (OAR) for breast cancer after modified radical mastectomy, aiming to provide evidence-based reference for clinical practice. Methods According to strict inclusion and exclusion criteria, literature search was performed in PubMed, Cochrane Library, FMRS, CNKI, Wanfang Data and VIP full text databases from the inception of databases up to March 2020. The controlled clinical trials of dosimetric comparison between VMAT and IMRT for breast cancer following modified radical mastectomy were selected. The meta-analysis was performed using Stata14software. Results The meta-analysis included 281 patients from 13 observational studies. Compared with IMRT, VMAT significantly increased the PTV dose coverage D95%(P<0.001) and significantly improved the PTV homogeneity index (HI,P<0.001) and conformity index (CI,P=0.004). Compared with IMRT, VMAT more effectively decreased the ipsilateral lung V20Gy (WMD=1.332,P=0.027) and contralateral lung V10Gy (P=0.003). There were no significant differences in theDmean, V5Gy, V10Gy and V30Gy of the ipsilateral lung,Dmean and V5Gy of the contralateral lung,Dmean,V10Gy and V30Gy of the heart between VMAT and IMRT (allP>0.05). Compared with VMAT, IMRT reduced the cardiac V5Gy (P=0.001). However, sensitivity analysis of included literature on cardiac V5Gy showed that the P value was reversed, indicating that the stability of the results was poor. VMAT significantly shortened the delivery time (P<0.001) and the number of monitor units (P<0.001) compared to IMRT. Conclusion Compared with IMRT, VMAT can achieves superior target dose coverage, HI and CI, better protection for the ipsilateral and contralateral lung, fewer monitor units and shorter delivery time.
Gao Yan,Zhong Heli,Li Zhuangling et al. Meta-analysis of dosimetric comparison between volumetric-modulated arc therapy and intensity-modulated radiotherapy for breast cancer after modified radical mastectomy[J]. Chinese Journal of Radiation Oncology, 2021, 30(11): 1159-1166.
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