Data Sheet 1_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.pdf

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.</p>Conclusions<p>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.</p>Systematic review registration<p>crd.york.ac.uk/PROSPERO/view/CRD420261439818, identifier CRD420261439818.</p>