癌症的呼吸控制和放射治疗：技术基础、临床证据和未来方向
Respiratory control and radiation therapy in breast cancer: Technical foundations, clinical evidence, and future directions.
摘要(中文译文)
放射治疗（RT）是乳腺癌治疗的基石，可改善局部区域控制、远处控制以及生存率。然而，对于左侧肿瘤患者及需要区域淋巴结照射的患者，心脏和肺与靶区的解剖邻近性增加了放射性心肺副作用的风险。呼吸控制是一项经临床验证的技术，通过在吸气时使胸腔内结构远离高剂量区域来降低这一风险。本叙述性综述提供了乳腺癌放疗中呼吸控制技术的综合性多学科整合，融合了其放射生物学原理、剂量学表现、临床结局以及在当代治疗平台（包括三维适形放疗（3D-CRT）、调强放疗（IMRT）、容积旋转调强放疗（VMAT）和质子治疗）中的技术实施。本文批判性评估了实施障碍——尤其是在低收入和中等收入国家（LMICs）——并提出了全球推广的务实策略，包括简化方案、共享资源模式和能力建设举措。最终，呼吸控制体现了生理学创新、技术精准与以生存者为中心的照护的融合，同时对外科工作流程管理和运营效率提出了挑战。将其纳入常规实践可提高治疗比，符合精准肿瘤学的原则，并提供一种可扩展、具有成本效益的策略，以减少全球在获得高质量乳腺癌治疗方面的不平等。
Abstract
Radiation therapy (RT) is a cornerstone in the management of breast cancer, improving locoregional, distant control, as well as survival. Nevertheless, for patients with left-sided tumours and those requiring regional nodal irradiation, the anatomical proximity of the heart and lungs to the target volumes increases the risk of radiation-associated cardiopulmonary side effects. Respiratory control is a clinically validated technique that mitigates this risk by displacing intrathoracic structures away from high-dose regions during inspiration. This narrative review provides a comprehensive, multidisciplinary synthesis of respiratory control techniques in breast cancer RT, integrating its radiobiological rationale, dosimetric performance, clinical outcomes, and technical implementation across contemporary treatment platforms including three-Dimensional Conformal Radiation Therapy (3D-CRT), Intensity-Modulated Radiation Therapy (IMRT), Volumetric Modulated Arc Therapy (VMAT), and proton therapy. Implementation barriers-particularly in low- and middle-income countries (LMICs) -are critically evaluated, and pragmatic strategies for global dissemination are proposed, including simplified protocols, shared-resource models, and capacity-building initiatives. Ultimately, respiratory control exemplifies the convergence of physiologic innovation, technological precision, and survivorship-centred care, while challenging workflow management and operational efficiency. Its incorporation into routine practice enhances the therapeutic ratio, aligns with the principles of precision oncology, and offers a scalable, cost-effective strategy to reduce global inequalities in access to high-quality breast cancer treatment.
如何引用
AMA
Gustavo Nader Marta, Orit Kaidar-Person, Icro Meattini, Tarek Hijal, Wellington Furtado Pimenta Neves Junior, Arley Gabriel Silva Correa, et al. Respiratory control and radiation therapy in breast cancer: Technical foundations, clinical evidence, and future directions.. Critical reviews in oncology/hematology. 2026; doi:10.1016/j.critrevonc.2026.105354.
APA
Gustavo Nader Marta, Orit Kaidar-Person, Icro Meattini, Tarek Hijal, Wellington Furtado Pimenta Neves Junior, Arley Gabriel Silva Correa, et al (2026). Respiratory control and radiation therapy in breast cancer: Technical foundations, clinical evidence, and future directions.. Critical reviews in oncology/hematology. https://doi.org/10.1016/j.critrevonc.2026.105354
GB/T 7714
Gustavo Nader Marta, Orit Kaidar-Person, Icro Meattini, Tarek Hijal, Wellington Furtado Pimenta Neves Junior, Arley Gabriel Silva Correa, et al. Respiratory control and radiation therapy in breast cancer: Technical foundations, clinical evidence, and future directions.[J]. Critical reviews in oncology/hematology, 2026 doi:10.1016/j.critrevonc.2026.105354.
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