Effectiveness of different accelerated partial breast irradiation techniques for the treatment of breast cancer patients: Systematic review using indirect comparisons of randomized clinical trials |
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| Institution: | 1. Department of Radiation Oncology – Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91, Sao Paulo, SP 01308-050, Brazil;2. Department of Radiology and Oncology – Radiation Oncology Unit. of University of São Paulo, Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo, Rua Dona Adma Jafet, 91, Sao Paulo, 01308-050 SP, Brazil;3. MRC Biostatistics Unit, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0SR, United Kingdom;4. Cochrane Brazil, Rua Borges Lagoa, 564 – Cj 63, Edifício São Paulo, Vila Clementino, São Paulo, SP 04038-000, Brazil;5. Department of Breast Cancer, Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91, Sao Paulo, 01308-050 SP, Brazil;6. Department of Radiation Oncology – Institut Curie, 6 rue d’Ulm, 75248 Paris cedex 05, France;7. Discipline of Emergency Medicine and Evidence-Based Medicine, Universidade Federal de São Paulo – Escola Paulista de Medicina (UNIFESP-EPM), Rua Borges Lagoa, 564 – Cj 63, Edifício São Paulo, Vila Clementino, São Paulo, 04038-000 SP, Brazil |
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| Abstract: | AimThis systematic review was conducted to compare the effectiveness of different accelerated partial breast irradiation (APBI) techniques for the treatment of breast cancer patients.BackgroundNumerous (APBI) techniques are available for clinical practice.Methods and materialsSystematic review of randomized controlled trials of APBI versus whole breast irradiation (WBI). The data from APBI studies were extracted for the analyses. Indirect comparisons were used to compare different APBI techniques.ResultsTen studies fulfilled the inclusion criteria. A total of 4343 patients were included, most of them with tumor stage T1-T2 and N0. Regarding APBI techniques, six trials used external beam radiation therapy; one intraoperative electrons; one intraoperative low-energy photons; one brachytherapy; and one external beam radiation therapy or brachytherapy. The indirect comparisons related to 5-years local control and 5-years overall survival were not significantly different between APBI techniques.ConclusionsBased on indirect comparisons, no differences in clinical outcomes were observed among diverse APBI techniques in published clinical trials that formally compared WBI to APBI. However wide confidence intervals and high risk of inconsistency precluded a sound conclusion. Further head-to-head clinical trials comparing different APBI techniques are required to confirm our findings. Studies comparing different techniques using individual participant data and/or real-life data from population-based studies/registries could also provide more robust results. |
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| Keywords: | Breast cancer Breast-conserving therapy Radiation therapy Accelerated partial breast irradiation APBI |
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