Jayant S Vaidya1, Max Bulsara2, Frederik Wenz3, Nathan Coombs4, Julian Singer5, Stephen Ebbs6, Samuele Massarut7, Christobel Saunders8, Michael Douek9, Norman R Williams10, David Joseph11, Jeffrey S Tobias12, Michael Baum10. 1. Division of Surgery and Interventional Science, University College London, London, UK; Department of Surgery, Royal Free Hospital, London, UK; Department of Surgery, Whittington Health, London, UK. Electronic address: jayant.vaidya@ucl.ac.uk. 2. Department of Biostatistics, University of Notre Dame, Fremantle, WA, Australia. 3. Department of Radiation Oncology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany. 4. Department of Surgery, Great Western Hospital, Swindon, UK. 5. Department of Clinical Oncology, The Princess Alexandra Hospital, Harlow, UK. 6. Croydon University Hospital, Croydon, UK. 7. National Cancer Institute, Centro di Riferimento Oncologico, Aviano, Italy. 8. School of Surgery, University of Western Australia, Perth, WA, Australia. 9. Department of Surgery, Kings College London, London, UK. 10. Division of Surgery and Interventional Science, University College London, London, UK. 11. Departments of Radiation Oncology, and Surgery, Sir Charles Gairdner Hospital, Perth, WA, Australia. 12. Department of Clinical Oncology, University College London Hospitals, London, UK.
Abstract
PURPOSE: 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.
PURPOSE: 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.
Authors: Sara Garduño-Sánchez; Isabel Villanego-Beltrán; María Dolores de Las Peñas-Cabrera; Javier Jaén-Olasolo Journal: Clin Transl Oncol Date: 2022-03-30 Impact factor: 3.340
Authors: David Krug; René Baumann; Wilfried Budach; Jürgen Dunst; Petra Feyer; Rainer Fietkau; Wulf Haase; Wolfgang Harms; Marc D Piroth; Marie-Luise Sautter-Bihl; Felix Sedlmayer; Rainer Souchon; Frederik Wenz; Rolf Sauer Journal: Radiat Oncol Date: 2017-01-23 Impact factor: 3.481
Authors: S Garduño-Sánchez; I Villanego-Beltrán; M Dolores de Las Peñas-Cabrera; J Jaén-Olasolo Journal: Clin Transl Oncol Date: 2021-07-02 Impact factor: 3.405