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The radiation dose tolerance of the brachial plexus: A systematic review and meta- analysis
Michael Yan, Weidong Kong, Andrew Kerr, Michael Brundage Clinical and Translational Radiation Oncology Volume 18, Pages (September 2019) DOI: /j.ctro Copyright © 2019 The Authors Terms and Conditions
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Fig. 1 PRISMA diagram. A total of 1983 studies were screened, with 163 articles selected for full text review. A total of 25 studies were included in the review. Clinical and Translational Radiation Oncology , 23-31DOI: ( /j.ctro ) Copyright © 2019 The Authors Terms and Conditions
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Fig. 2 Incidence of radiation induced brachial plexopathy versus absorbed plexus dose. Radiation induced brachial plexopathy (RIBP) incidence vs. EQD2 dose absorbed is plotted for all cohorts, and stratified by planning methodology. Lines denote both the current brachial plexus dose constraint of 60 Gy, as well as the 5% RIBP incidence level. Abbreviations: RIBP = radiation induced brachial plexopathy. EQD2 = equivalent dose in 2 Gy fractions. Clinical and Translational Radiation Oncology , 23-31DOI: ( /j.ctro ) Copyright © 2019 The Authors Terms and Conditions
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Fig. 3 Individual Study and Overall Relative Risk of Relationships between Brachial Plexus Maximum Dose and Brachial Plexopathy Risk. The size of each data maker represents the weighting factor (1/SE2) assigned to the study. For the combined result, the width of the diamond represents the 95% confidence interval of the summated results. Clinical and Translational Radiation Oncology , 23-31DOI: ( /j.ctro ) Copyright © 2019 The Authors Terms and Conditions
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Fig. 4 Relative Risk of Radiation Induced Brachial Plexopathy in Relation to Brachial Plexus Maximum Dose. (A) The relationship between brachial plexus maximum dose and RIBP risk are denoted for the 5 individual studies. Data points correspond to median values of the endpoint category (filled) and reference category (open) respectively. Numbers correspond to the references for original studies. (B) RR values are converted to continuous estimates per Gy increase of dose, which is represented by the slope. The bolded line represents the weighted cumulative average of the individual RRs, with the shaded region representing the 95% confidence interval. Abbreviations: RR = relative risk; RIBP = radiation induced brachial plexopathy. Clinical and Translational Radiation Oncology , 23-31DOI: ( /j.ctro ) Copyright © 2019 The Authors Terms and Conditions
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Supplementary figure 1 Funnel Plot of the Relationship Between Relative Risk and Standard Error of the Log RR for Radiation Induced Brachial Plexopathy. Relative Risk (RR) estimates are the effect per Gy increase in brachial plexus maximum dose. The cumulative RR (1.11) from all included studies is represented by the central line. Filled circles are the 5 included studies, and the open circle is the study generated by the trim and fill approach to account for publication bias. Clinical and Translational Radiation Oncology , 23-31DOI: ( /j.ctro ) Copyright © 2019 The Authors Terms and Conditions
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