Reduced Mortality With Partial-Breast Irradiation for Early Breast Cancer: A Meta-Analysis of Randomized Trials

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• 作者：Jayant S. Vaidya ; MBBS ; MS ; DNB ; FRCS ; PhD^&lowast ; ; ^&dagger ; ; ^&Dagger ; ; ^{jayant.vaidya@ucl.ac.uk" class="auth_mail" title="E-mail the corresponding author} ; Max Bulsara ; PhD^§ ; ; Frederik Wenz ; MD^‖ ; Nathan Coombs ; BSc ; BM ; FRCS^¶ ; ; Julian Singer ; MBBS ; MRCP ; FRCR^# ; Stephen Ebbs ; MD ; FRCS^&lowast ; &lowast ; ; Samuele Massarut ; MD^&dagger ; &dagger ; ; Christobel Saunders ; FRCS^&Dagger ; &Dagger ; ; Michael Douek ; MBBS ; MD ; FRCS^§ ; § ; ; Norman R. Williams ; BSc ; PhD ; CSci ; MICR ; FIBMS^&lowast ; ; David Joseph ; MD ; FRCR^‖‖ ; Jeffrey S. Tobias ; MD ; FRCS^¶ ; ¶ ; ; Michael Baum ; MBBS ; MD ; FRCS^&lowast ;
• 刊名：International Journal of Radiation Oncology*Biology*Physics
• 出版年：2016
• 出版时间：1 October 2016
• 年：2016
• 卷：96
• 期：2
• 页码：259-265
• 全文大小：270 K

文摘

With earlier detection and more effective treatment, mortality from breast cancer continues to fall and it has become increasingly important to reduce the toxicity of treatments. Partial-breast radiation therapy, which focuses radiation to the tumor bed, may achieve this aim. We analyzed mortality differences in randomized trials of partial-breast irradiation (PBI).

Methods and Materials

We included data from published randomized trials of PBI (alone or as part of a risk-adapted approach) versus whole-breast irradiation (WBI) for invasive breast cancer suitable for breast-conserving therapy. We identified trials using PubMed and Google searches with the terms “partial breast irradiation” OR “intraoperative radiotherapy” OR “IMRT” OR (“accelerated” AND “radiation”) AND “randomised/randomized,” as well as through discussion with colleagues in the field. We calculated the proportion of patients who had events in each randomized arm at 5 years' follow-up and created a forest plot using Stata, version 14.1.

Results

We identified 9 randomized trials of PBI versus WBI in invasive breast cancer; 5-year outcomes were available for non–breast cancer mortality in 5 trials (n=4489) and for breast cancer mortality in 4 trials (n=4231). The overall mortality was 4.9%. There was no detectable heterogeneity between the trials for any of the outcomes. There was no difference in the proportion of patients dying of breast cancer (difference, 0.000% [95% confidence interval (CI), −0.7 to +0.7]; P=.999). Non–breast cancer mortality with PBI was lower than with WBI (difference, 1.1% [95% CI, −2.1% to −0.2%]; P=.023). Total mortality with PBI was also lower than with WBI (difference, 1.3% [95% CI, −2.5% to 0.0%]; P=.05).

Conclusions

Use of PBI instead of WBI in selected patients results in a lower 5-year non–breast cancer and overall mortality, amounting to a 25% reduction in relative terms. This information should be included when breast-conserving therapy is proposed to a patient.