SynthesisFrontiers in oncology2026
Surface-guided deep-inspiration breath-hold radiotherapy for left-sided breast cancer: a systematic review and meta-analysis of dosimetric outcomes and image-verified setup accuracy.
Synthesis in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Deep-inspiration breath-hold (DIBH) reduces cardiac and pulmonary radiation exposure during radiotherapy for left-sided breast cancer. Surface-guided radiotherapy (SGRT) and optical surface monitoring systems (OSMS) can support patient positioning and breath-hold monitoring, but evidence specific to SGRT/OSMS-assisted DIBH workflows remains fragmented. Methods: PubMed, Web of Science, Embase, and Cochrane CENTRAL were searched from inception to May 21, 2026. Studies using SGRT/OSMS-assisted DIBH and reporting extractable dosimetric or image-verified setup outcomes were eligible. Effects were expressed as mean differences (MDs) with 95% confidence intervals (CIs); dosimetric MDs were defined as SGRT/OSMS-assisted DIBH minus FB, with negative values indicating lower doses. Random-effects meta-analyses were used for dosimetric and comparative setup outcomes, whereas single-arm setup data were pooled separately. Results: A total of 52 studies were included. Compared with free breathing (FB), SGRT/OSMS-assisted DIBH was associated with lower mean heart dose (MD = -1.21 Gy, 95% CI -1.48 to -0.93), mean left anterior descending coronary artery (LAD) dose (MD = -7.05 Gy, 95% CI -9.39 to -4.71), ipsilateral (left) lung mean dose (MD = -0.88 Gy, 95% CI -1.34 to -0.42), and ipsilateral lung V20 (MD = -2.30 percentage points, 95% CI -3.27 to -1.32). Comparative meta-analyses found no statistically significant pooled between-group differences in image-verified 3D-vector, left-right/lateral (LR/LAT), superior-inferior/longitudinal/craniocaudal (SI/LNG/CC), or anterior-posterior/vertical (AP/VRT) residual setup errors; this finding does not establish equivalence or non-inferiority. Sensitivity analyses generally supported the main conclusions, although the magnitude of the ipsilateral lung V20 effect was sensitive to the statistical model. Conclusions: SGRT/OSMS-assisted DIBH was associated with lower cardiac, LAD, and ipsilateral lung doses in left-sided breast radiotherapy. Comparative setup analyses found no statistically significant pooled differences from the comparator workflows reported in the primary studies; this does not establish equivalence or non-inferiority. Current evidence supports SGRT/OSMS for external positioning, real-time DIBH monitoring, and quality assurance, while appropriate internal image verification should be retained according to target complexity, the SGRT system, and the local quality assurance program. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261439818, identifier CRD420261439818.
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