105: Is Whole Breast Irradiation Better Than Endocrine Therapy in Early Stage Breast Cancer? A Network Meta-Analysis of Published Randomized Trials

Abstract Background：Hypofractionated whole breast irradiation (HF-WBI) can achieve the same treatment effect as conventional fractionated whole breast irradiation (CF-WBI) within limits , without increasing adverse reactions. Because of its characteristics of reducing the number of radiation therapy (RT) during the COVID-19 Pandemic, it is recommended as the first choice of treatment for patients with early breast cancer after breast conserving surgery. However, the choice of RT is still under exploration. Here, we conducted a network meta-analysis to evaluate the problem comprehensively using data from new randomized trials. Methods: We analyzed data from eligible studies for published events for ipsilateral breast tumor recurrence (IBTR), distant metastasis, total deaths, and non-breast cancer-related deaths. Statistical analysis was performed using a fixed-effects or random-effects model in cases of low and high heterogeneity, respectively. Network meta-analysis was conducted using a node-splitting model for two-category data among three RTs based on a Bayesian approach.Results: 16 studies with 23,418 patients were included. For IBTR, pairwise comparison showed that CF-WBI was significantly better than PBI, and HF-WBI was similar to CF-WBI. HF-WBI was superior to PBI, but the difference was not significant. However, indirect comparison of three RTs by network meta-analysis showed that HF-WBI was significantly better than PBI (OR=0.67, CI95%: 0.46–0.95). Paired and network meta-analyses found no significant differences in other endpoints among three radiotherapies. Conclusion: This meta-analysis demonstrated PBI was associated with increased IBTR compared with HF-WBI or CF-WBI in early-stage breast cancer patients.

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PH-0596: Whole breast irradiation in comparison to endocrine therapy in early stage breast cancer

Radiotherapy and Oncology ◽

10.1016/s0167-8140(21)00618-6 ◽

2020 ◽

Vol 152 ◽

pp. S335-S336

Author(s):

J. Haussmann ◽

W. Budach ◽

S. Corradini ◽

B. Tamaskovics ◽

E. Boelke ◽

...

Keyword(s):

Breast Cancer ◽

Endocrine Therapy ◽

Early Stage ◽

Early Stage Breast Cancer ◽

Whole Breast Irradiation ◽

Breast Irradiation

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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

Cancers ◽

10.3390/cancers12082309 ◽

2020 ◽

Vol 12 (8) ◽

pp. 2309

Author(s):

Jan Haussmann ◽

Wilfried Budach ◽

Stefanie Corradini ◽

David Krug ◽

Balint Tamaskovics ◽

...

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Randomized Trials ◽

Early Stage ◽

Meta Analysis ◽

Early Stage Breast Cancer ◽

Effect Sizes ◽

Breast Irradiation ◽

Breast Radiotherapy ◽

Whole Breast Radiotherapy

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%: 0.89–1.16; p = 0.810, and n = 15,203; RD = −0.001; CI-95%: −0.008–0.006; p = 0.785) and BCSS (n = 15,203; RD = 0.001; CI-95%: −0.002–0.005; p = 0.463). PBI also did not result in a significant decrease of NBCD (n = 15,203; RD = −0.003; CI-95%: −0.010–0.003; 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.

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Toxicity and clinical outcomes of partial breast irradiation compared to whole breast irradiation for early-stage breast cancer: a systematic review and meta-analysis

Breast Cancer Research and Treatment ◽

10.1007/s10549-019-05209-9 ◽

2019 ◽

Vol 175 (3) ◽

pp. 531-545 ◽

Cited By ~ 8

Author(s):

Yasmin Korzets ◽

Anthony Fyles ◽

Daniel Shepshelovich ◽

Eitan Amir ◽

Hadar Goldvaser

Keyword(s):

Breast Cancer ◽

Systematic Review ◽

Clinical Outcomes ◽

Early Stage ◽

Meta Analysis ◽

Early Stage Breast Cancer ◽

Partial Breast Irradiation ◽

Whole Breast Irradiation ◽

Breast Irradiation

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A meta-analysis of the efficacy and safety of accelerated partial breast irradiation versus whole-breast irradiation for early-stage breast cancer

Radiation Oncology ◽

10.1186/s13014-021-01752-2 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Xiaoyong Xiang ◽

Zhen Ding ◽

Lingling Feng ◽

Ning Li

Keyword(s):

Breast Cancer ◽

Local Recurrence ◽

Early Stage ◽

Meta Analysis ◽

Disease Free Survival ◽

Early Stage Breast Cancer ◽

Accelerated Partial Breast Irradiation ◽

Partial Breast Irradiation ◽

Whole Breast Irradiation ◽

Breast Irradiation

Abstract Objective This meta-analysis evaluated the efficacy and safety of accelerated partial breast irradiation versus whole-breast irradiation for early-stage breast cancer after breast-conserving surgery. Materials and methods A systematic search of PubMed, Embase, and the Cochrane libraries was performed according to the PRISMA statement the last 10 years to April 7, 2020 to identify the randomized controlled trials of APBI versus WBI for treating patients with early-stage breast cancer. Two independent observers evaluated the identified studies. The obtained data were analyzed using the RevMan 5.3 software. Results A total of 10 randomized controlled trials involving 15,500 patients with early-stage breast cancer were selected according to the inclusion and exclusion criteria and included in this meta-analysis. In this meta-analysis, we included ten studies that reported local recurrence and found significant differences in local recurrence rates (HR = 1.46; 95% CI 1.20–1.79, P = 0.0002). Further analysis showed that this difference may be related to the choice of treatment methods. No differences in distant metastasis, breast cancer deaths, contralateral breast cancer, disease-free survival, and overall survival rates were observed between WBI and APBI groups. There was no significant difference in late toxicity, cosmetic outcomes and quality of life between the two groups, the compliance and tolerance of the patients were well. Compared to whole breast irradiation, accelerated partial breast irradiation significantly reduced serious (≥ grade 2) early toxicities, especially regarding acute skin toxicity. Conclusions The analysis showed that patients receiving APBI had a higher local recurrence rate, but no differences in distant metastasis, breast cancer deaths, contralateral breast cancer, disease-free survival, and overall survival rates.

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