No Difference in Overall Survival and Non-Breast Cancer Deaths after Partial Breast Radiotherapy Compared to Whole Breast Radiotherapy—A Meta-Analysis of Randomized Trials
| Autor: | Ioannis Simiantonakis, Balint Tamaskovics, Jan Haussmann, Edwin Bölke, Wilfried Budach, David Krug, Kai Kammers, Christiane Matuschek, Stefanie Corradini, Freddy Joel Djiepmo-Njanang |
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| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Oncology
Cancer Research medicine.medical_specialty medicine.medical_treatment radiation therapy lcsh:RC254-282 Article 03 medical and health sciences 0302 clinical medicine Breast cancer Whole Breast Irradiation Internal medicine medicine Breast-conserving surgery cancer study 030212 general & internal medicine investigation business.industry Hazard ratio Cancer Partial Breast Irradiation medicine.disease lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens Radiation therapy 030220 oncology & carcinogenesis Meta-analysis randomized business |
| Zdroj: | Cancers, Vol 12, Iss 2309, p 2309 (2020) Cancers Volume 12 Issue 8 |
| ISSN: | 2072-6694 |
| Popis: | Purpose/objective: Adjuvant radiotherapy after breast conserving surgery is the standard approach in early stage breast cancer. However, the extent of breast tissue that has to be targeted with radiation has not been determined yet. Traditionally, the whole breast was covered by two opposing tangential beams. Several randomized trials have tested partial breast irradiation (PBI) compared to whole breast irradiation (WBI) using different radiation techniques. There is evidence from randomized trials that PBI might result in lower mortality rates compared to WBI. We aimed to reassess this question using current data from randomized trials. Material/methods: We performed a systematic literature review searching for randomized trials comparing WBI and PBI in early stage breast cancer with publication dates after 2009. The meta-analysis was performed using the published event rates and the effect sizes for overall survival (OS), breast cancer-specific survival (BCSS), and non-breast cancer death (NBCD) as investigated endpoints. Analysis of subgroups using different radiation techniques was intended. We used hazard ratios (HR) and risk differences (RD) to estimate pooled effect sizes. Statistical analysis was performed using the inverse variance heterogeneity model. Results: We identified eleven studies randomizing between PBI and WBI. We did not find significant differences in OS (n = 14,070 HR = 1.02 CI-95%: 0.89&ndash 1.16 p = 0.810, and n = 15,203 RD = &minus 0.001 CI-95%: &minus 0.008&ndash 0.006 p = 0.785) and BCSS (n = 15,203 RD = 0.001 0.002&ndash 0.005 p = 0.463). PBI also did not result in a significant decrease of NBCD (n = 15,203 0.003 0.010&ndash p = 0.349). A subgroup analysis by radiation technique also did not point to any detectable differences. Conclusion: In contrast to a previous assessment of mortality, we could not find a detrimental effect of WBI on OS or NBCD. A longer follow-up might be necessary to fully assess the long-term mortality effects of PBI compared to WBI. |
| Databáze: | OpenAIRE |
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