SGRT in the treatment of left breast in forced inspiration: systematic literature review

• Autor(a) principal: Pires, Pedro
• Data de Publicação: 2023
• Outros Autores: Monsanto, Fátima, Furtado, Ana
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: https://doi.org/10.25758/set.767
• topic: Radioterapia guiada por superfície; SGRT; Radioterapia da mama esquerda; Inspiração forçada profunda; DIBH; Surface-Guided Radiation Therapy; Left breast radiation therapy; Deep inspiration breath-hold; SGRT; DIBH

Introduction – Left breast radiotherapy is known to negatively affect the heart and coronary arteries by irradiating them, increasing cardiac toxicity and the risk of heart problems. With the innovative techniques of Surface-Guided Radiation Therapy (SGRT) and Deep Inspiration Breath Hold (DIBH) combined it is intended to evaluate the benefits of this treatment, increasing its reproducibility, and reducing toxicity in organs at risk in radiation therapy to the left breast. Methods – This systematic literature review followed PRISMA guidelines, using four databases: Scopus, Web of Science, PubMed, and ScienceDirect, using the Boolean operator AND and the following descriptors: SGRT, left breast cancer, and DIBH. The study selection process was divided into three steps: identification, screening, and inclusion, to select and analyze the studies. The inclusion criteria applied were: studies published between 2017 and 2022, in full text with open access, articles written in English, and primary source articles. The exclusion criteria used were: studies that do not evaluate DIBH and SGRT techniques together, review articles, and studies that do not exclusively evaluate left breast cancer. In addition to these criteria, technical notes and studies that contradict the objectives of the present study were excluded. After the selection process, a total of seven articles were obtained. Results – Seven studies were selected for quantitative analysis and a summary table was created. These studies reflect current clinical practice in the joint use of the techniques under study. There were no significant deviations. In general, doses were reduced in the heart and lungs and the left anterior descending coronary artery. Discussion – The clinical workflow protocols of the different authors show agreement with each other. According to studies by Zhang et al., Rice et al., and Kügele et al., the use of DIBH with SGRT decreases the dose in organs at risk, reducing the probability of radiation-induced morbidities. Studies also show that these techniques allow stability and reproducibility to be maintained during treatment. Conclusion – SGRT combined with DIBH reduces the risk of cardiovascular and pulmonary toxicity in patients undergoing left breast radiotherapy, allowing the reduction of complications adjacent to this treatment, such as: pericarditis, cardiac ischemia, myocardial infarction and decreasing deaths due to cardiovascular pathology. SGRT systems are constantly evolving, and guidelines have recently been published to ensure the safe and efficient implementation of this technique.