{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T05:04:56Z","timestamp":1789621496759,"version":"build-2803163510"},"reference-count":71,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005149","name":"Cancer Institute and Hospital, Chinese Academy of Medical Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005149","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats: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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420261439818<\/jats:ext-link>\n                      , identifier CRD420261439818.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1936561","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T04:47:30Z","timestamp":1789620450000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Surface-guided deep-inspiration 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