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Hypofractionated whole breast radiotherapy in breast conservation for early-stage breast cancer: a systematic review and meta-analysis of randomized trials

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Abstract

Purpose

Breast conservation therapy (BCT) for early-stage breast cancer involves lumpectomy followed by whole breast radiotherapy, which can involve either standard fractionation (SRT) or accelerated fractionation (ART). This systematic review and meta-analysis was performed to determine whether any benefit exists for ART or SRT.

Materials and methods

We searched MEDLINE (1966–2014), all seven databases of the Cochrane Library (1968–2014), EMBASE (1974–2014), clinicaltrials.gov, ISRCTN, WHO ICTRP, and meeting abstracts in the Web of Science Core Collection (1900–2014). RCTs comparing SRT to ART among women undergoing BCT with stage T1–T2 and/or N1 breast cancer or carcinoma in situ were included. Follow-up was 30 days for acute toxicity, or three years for disease control and late toxicity.

Results

13 trials with 8189 participants were included. No differences were observed in local failure (n = 7 trials; RR 0.97; 95% CI 0.78–1.19, I 2 = 0%), locoregional failure, (n = 8 trials; RR 0.86; 95% CI 0.63–1.16, I 2 = 0%), or survival (n = 4 trials; RR 1.00; 95% CI 0.85–1.17, I 2 = 0%). ART was associated with significantly less acute toxicity (n = 5 trials; RR 0.36; 95% CI 0.21–0.62, I 2 = 20%), but no difference in late cosmesis (RR 0.95; 95% CI 0.81–1.12, I 2 = 54%).

Conclusions

ART use does not reduce disease control or worsen long-term cosmetic outcome, and may decrease the risk of acute radiation toxicity as compared to SRT.

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Author information

Authors and Affiliations

  1. The Geisel School of Medicine at Dartmouth, Hanover, NH, USA

    Luca F. Valle, Kathleen E. Bickel & Nirav S. Kapadia

  2. The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA

    Surbhi Agarwal, Haley A. Herchek & Nirav S. Kapadia

  3. Duke Cancer Institute, Durham, NC, USA

    David C. Nalepinski

  4. Norris Cotton Cancer Center at Dartmouth Hitchcock Medical Center, Lebanon, NH, USA

    Nirav S. Kapadia

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  1. Luca F. Valle
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  2. Surbhi Agarwal
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Correspondence to Luca F. Valle.

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Valle, L.F., Agarwal, S., Bickel, K.E. et al. Hypofractionated whole breast radiotherapy in breast conservation for early-stage breast cancer: a systematic review and meta-analysis of randomized trials. Breast Cancer Res Treat 162, 409–417 (2017). https://doi.org/10.1007/s10549-017-4118-7

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  • DOI: https://doi.org/10.1007/s10549-017-4118-7

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