乳腺癌保乳术后俯卧位与仰卧位放疗危及器官剂量比较的Meta分析

目的 探讨乳腺癌保乳术后采用俯卧位与仰卧位放疗危及器官的剂量差异，为临床实践提供证据。方法 制定严格的纳入和排除标准，全面检索PubMed、FMJS、CHKD和万方全文数据库。纳入乳腺癌保乳术后俯卧位与仰卧位危及器官剂量对比的相关研究。统计学处理采用Cochrane协作网提供的RevMan5.2统计软件计算标准化均差及其95%可信区间。结果 共检索到267篇文献，经评价后最终16个研究442例乳腺癌患者符合本系统评价的纳入标准。Meta分析结果显示：乳腺癌保乳术后患者采用俯卧位放疗患侧肺（SMD=-4.36，95%CI：-5.41~-3.31，P<0.001）和心脏（SMD=-0.24，95%CI：-0.4~-0.09，P<0.05）受照剂量明显低于仰卧位；对侧乳腺受照剂量在两种体位间差异无统计学意义（SMD=0.19，95%CI：-0.02~0.40，P>0.05）。结论 与仰卧位相比，乳腺癌保乳术后俯卧位放疗可明显降低心脏和患侧肺的受照剂量。

Dosimetric Comparison Between Prone and Supine Positions in Radiotherapy on Organs at Risk after Breast-conserving Surgery: A Meta-analysis

Objective To compare the dosimetric difference between prone position and supine position in breast cancer radiotherapy after breast-conserving surgery. Methods Strict inclusion and exclusion criteria were drew up. Trials were searched from PubMed, FMJS, CHKD and WanFang full-text database. Studies of the dosimetric comparisons between prone position and supine position in radiotherapy on organs at risk after breast-conserving surgery were included. Standardized mean difference and 95% confidence interval were computed by statistical software RevMan5.2 provided by the Cochrane collaboration. Results Finally, 16 trials containing 442 patients were included. The results of Meta-analysis showed that the radiation exposure of ipsilateral lung (SMD=-4.36, 95% CI: -5.41－-3.31, P<0.001) and the heart (SMD=-0.24, 95%CI: -0.4－-0.09, P<0.05) were dramatically lower in prone position than those in supine position, while the doses to contralateral breast did not differ between the two positions (SMD=0.19, 95%CI: -0.02~0.40, P>0.05). Conclusion Compared with supine position, prone position in breast radiotherapy is contributed to a significantly lower radiation dose for ipsilateral lung and heart of patients after breast-conserving surgery.