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Modificações de volume-alvo em radioterapia de carcinoma do pulmão de não pequenas células com tomografia computadorizada a quatro dimensões: uma revisão sistemática com meta-nálise
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Objetivos: Avaliar o impacto da tomografia computorizada a quatro dimensões na delimitação de volumes-alvo em radioterapia de carcinoma do pulmão de não pequenas células, através de uma revisão sistemática.
Métodos: O protocolo do estudo seguiu as diretrizes Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A pesquisa de literatura foi efetuada na base de dados EBSCO, PubMed®, Web of Science™ e Scopus®, contemplando os termos MeSH “Four-Dimensional Computed Tomography” e “Carcinoma, Non-Small-Cell Lung” e filtrando os artigos publicados desde 2007 até 28 de fevereiro de 2025. Foi estipulada a inclusão de estudos com realização de Tomografia Computadorizada a quatro dimensões para planeamento de radioterapia de doentes com carcinoma do pulmão de não pequenas células, com comparação com a realização de Tomografia Computadorizada em respiração livre, com descrição do impacto na delineação de volumes-alvo, publicados em língua inglesa, espanhola ou portuguesa. Foram considerados como critérios de exclusão estudos relativos a outras patologias que não carcinoma do pulmão de não pequenas, estudos em fantomas e em animais, e publicações em formato de case report, correspondência a editores ou revisões. Foi realizada uma síntese qualitativa dos principais resultados encontrados nos estudos incluídos, nomeadamente das variáveis demográficas e clínicas.
Na síntese quantitativa foi realizada meta-análise com recurso ao pacote METAFOR disponível no software open-source jamovi, versão 2.6.44.
Resultados: A pesquisa identificou inicialmente 1.267 estudos, dos quais 37 foram considerados potencialmente elegíveis, após a triagem, sendo selecionados para revisão do texto integral. Destes, 7 estudos cumpriram os critérios de inclusão e foram incluídos na revisão: todos observacionais transversais, com um total de 161 doentes. 6 estudos incluíam uma análise comparativa entre volumes, com 4 demonstrando uma diferença estatisticamente significativa. Valores absolutos dos volumes-alvo foram superiores todos os estudos em análise em respiração livre. Nos 4 estudos com dados de dose média no pulmão, a dose em respiração livre era sempre superior. A diferença de médias estandardizada do planning target volume nos estudos incluídos na meta-análise variou entre -1.615 to -0.098, com uma média das diferenças médias estandardizadas estimada em -0,497 (intervalo de confiança a 95% de [-1,049; 0,056]), não sendo estatisticamente diferente de 0 (z = -1.76, p = 0.078). Foi identificada uma heterogeneidade estatisticamente significativa entre estudos (Q(4)=11,99; p=0,017), com I² = 66,6%.Conclusão: Na radioterapia de carcinoma do pulmão de não pequenas células, a Tomografia Computadorizada a quatro dimensões poderá reduzir a extensão do volume- alvo, com uma diminuição da dose aos tecidos normais circundantes. No entanto, o efeito estimado pela meta-análise realizada não aparente ser significativo, o que poderá relacionar-se com o número de estudos, o número de participantes considerado e a heterogeneidade encontrada.
Objectives: To evaluate the impact of four-dimensional computed tomography on the delineation of target volumes in radiotherapy for non-small cell lung carcinoma through a systematic review. Methods: The study protocol followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The literature search was performed in the EBSCO, PubMed®, Web of Science™, and Scopus® databases, using the MeSH terms “Four-Dimensional Computed Tomography” and “Carcinoma, Non-Small-Cell Lung” and filtering articles published from 2007 to February 28, 2025. Studies were included that used four- dimensional computed tomography for radiotherapy planning in patients with non-small cell lung carcinoma, comparing it with computed tomography during free breathing, describing the impact on target volume delineation, and published in English, Spanish, or Portuguese. Studies related to pathologies other than non-small cell lung carcinoma, studies in phantoms and animals, and publications in the form of case reports, correspondence to editors, or reviews were considered exclusion criteria. A qualitative synthesis of the main results found in the included studies was performed, namely demographic and clinical variables. In the quantitative synthesis, a meta-analysis was performed using the METAFOR package available in the open-source software jamovi, version 2.6.44. Results: The search initially identified 1,267 studies, of which 37 were considered potentially eligible after screening and were selected for full-text review. Of these, seven studies met the inclusion criteria and were included in the review: all were cross-sectional observational studies, with a total of 161 patients. Six studies included a comparative analysis between volumes, with four showing a statistically significant difference. Absolute values of target volumes were higher in all studies analyzed in free breathing. In the four studies with mean lung dose data, the dose in free breathing was always higher. The standardized mean difference in planning target volume in the studies included in the meta-analysis ranged from -1. 615 to -0.098, with an estimated mean standardized difference of -0.497 (95% confidence interval [-1.049; 0.056]), which was not statistically different from 0 (z = -1.76, p = 0.078). Statistically significant heterogeneity was identified between studies (Q(4)=11.99; p=0.017), with I² = 66.6%. Conclusion: In radiotherapy for non-small cell lung cancer, four-dimensional computed tomography may reduce the target volume, with a decrease in the dose to surrounding normal tissues. However, the effect estimated by the meta-analysis does not appear to be significant, which may be related to the number of studies, the number of participants considered, and the heterogeneity found.
Objectives: To evaluate the impact of four-dimensional computed tomography on the delineation of target volumes in radiotherapy for non-small cell lung carcinoma through a systematic review. Methods: The study protocol followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The literature search was performed in the EBSCO, PubMed®, Web of Science™, and Scopus® databases, using the MeSH terms “Four-Dimensional Computed Tomography” and “Carcinoma, Non-Small-Cell Lung” and filtering articles published from 2007 to February 28, 2025. Studies were included that used four- dimensional computed tomography for radiotherapy planning in patients with non-small cell lung carcinoma, comparing it with computed tomography during free breathing, describing the impact on target volume delineation, and published in English, Spanish, or Portuguese. Studies related to pathologies other than non-small cell lung carcinoma, studies in phantoms and animals, and publications in the form of case reports, correspondence to editors, or reviews were considered exclusion criteria. A qualitative synthesis of the main results found in the included studies was performed, namely demographic and clinical variables. In the quantitative synthesis, a meta-analysis was performed using the METAFOR package available in the open-source software jamovi, version 2.6.44. Results: The search initially identified 1,267 studies, of which 37 were considered potentially eligible after screening and were selected for full-text review. Of these, seven studies met the inclusion criteria and were included in the review: all were cross-sectional observational studies, with a total of 161 patients. Six studies included a comparative analysis between volumes, with four showing a statistically significant difference. Absolute values of target volumes were higher in all studies analyzed in free breathing. In the four studies with mean lung dose data, the dose in free breathing was always higher. The standardized mean difference in planning target volume in the studies included in the meta-analysis ranged from -1. 615 to -0.098, with an estimated mean standardized difference of -0.497 (95% confidence interval [-1.049; 0.056]), which was not statistically different from 0 (z = -1.76, p = 0.078). Statistically significant heterogeneity was identified between studies (Q(4)=11.99; p=0.017), with I² = 66.6%. Conclusion: In radiotherapy for non-small cell lung cancer, four-dimensional computed tomography may reduce the target volume, with a decrease in the dose to surrounding normal tissues. However, the effect estimated by the meta-analysis does not appear to be significant, which may be related to the number of studies, the number of participants considered, and the heterogeneity found.
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Tomografia computadorizada a quatro dimensões Carcinoma do pulmão de não pequenas células Radioterapia Four-dimensional computed tomography Non-small cell lung carcinoma Radiotherapy