Comparison of the Oncological Efficacy Between Intraoperative Radiotherapy With Whole-Breast Irradiation for Early Breast Cancer: A Meta-Analysis

BackgroundIntraoperative radiotherapy (IORT) and whole-breast irradiation (WBI) are both effective radiotherapeutic interventions for early breast cancer patients undergoing breast-conserving surgery; however, an issue on whether which one can entail the better prognosis is still controversial. Our study aimed to investigate the 5-year oncological efficacy of the IORT cohort and the WBI cohort, respectively, and compare the oncological efficacy between the cohorts.Materials and MethodsWe conducted a computerized retrieval to identify English published articles between 2000 and 2021 in the PubMed, the Web of Science, the Cochrane Library, and APA PsycInfo databases. Screening, data extraction, and quality assessment were performed in duplicate.ResultsA total of 38 studies were eligible, with 30,225 analyzed participants. A non-comparative binary meta-analysis was performed to calculate the weighted average 5-year local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and overall survival (OS) in the two cohorts, respectively. The LRFS, DMFS, and OS (without restriction on the 5-year outcomes) between the two cohorts were further investigated by a comparative binary meta-analysis. The weighted average 5-year LRFS, DMFS, and OS in the IORT cohort were 96.3, 96.6, and 94.1%, respectively, and in the WBI cohort were 98.0, 94.9, and 94.9%, respectively. Our pooled results indicated that the LRFS in the IORT cohort was significantly lower than that in the WBI cohort (pooled odds ratio [OR] = 2.36; 95% confidential interval [CI], 1.66–3.36). Nevertheless, the comparisons of DMFS (pooled OR = 1.00; 95% CI, 0.76–1.31), and OS (pooled OR = 0.95; 95% CI, 0.79–1.14) between the IORT cohort with the WBI cohort were both not statistically significant.ConclusionsDespite the drastically high 5-year oncological efficacy in both cohorts, the LRFS in the IORT cohort is significantly poorer than that in the WBI cohort, and DMFS and OS do not differ between cohorts.

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The Role of Radiotherapy Fractionation And Volume In Patients With Early Breast Cancer After Conserving Surgery: A Systematic Review And Network Meta-Analysis

10.21203/rs.3.rs-152455/v1 ◽

2021 ◽

Author(s):

Xian Chen ◽

Tong-Xin Yang ◽

Yao-Xiong Xia ◽

Qi Shen ◽

Yu Hou ◽

...

Keyword(s):

Breast Cancer ◽

Early Breast Cancer ◽

Fixed Effects ◽

Early Stage ◽

Meta Analysis ◽

Indirect Comparison ◽

Whole Breast Irradiation ◽

Breast Irradiation ◽

First Choice ◽

Better Than

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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