Intensity-modulated radiation therapy for early-stage breast cancer: a systematic review and meta-analysis
| Title: | Intensity-modulated radiation therapy for early-stage breast cancer: a systematic review and meta-analysis |
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| Authors: | Samir Abdallah Hanna, Bruna Salani Mota, Fabio Ynoe de Moraes, Gustavo Nader Marta, Heloísa de Andrade Carvalho, Rachel Riera |
| Source: | São Paulo Medical Journal, Vol 143, Iss 1 (2024) |
| Publisher Information: | Associação Paulista de Medicina, 2024. |
| Publication Year: | 2024 |
| Collection: | LCC:Medicine |
| Subject Terms: | Intensity-modulated radiotherapy, Breast neoplasms, Adjuvant radiotherapy, Breast cancer, Breast-conservative treatment, Postoperative radiotherapy, Acute toxicity, Late toxicity, Medicine |
| More Details: | ABSTRACT BACKGROUND: Radiation therapy (RT) is a standard treatment for non-metastatic breast cancer and is associated with acute and late toxicities. Intensity-modulated RT (IMRT) may decrease toxicity and is convenient for patients. OBJECTIVES: To assess the efficacy and safety of IMRT in women with early stage breast cancer. DESIGN AND SETTING: Systematic review study; Multi-institutional centers. METHODS: Seven databases were searched. Randomized controlled trials (RCT) comparing IMRT with any “non-IMRT” strategies were included. Primary outcomes were local control and acute toxicity. Cochrane Handbook was use to plan and conduct the review, and PRISMA 2020 was used to report results. RESULTS: Five RCT involving 2,556 women (n = 1,283 IMRT; n = 1,274 control arm) were included. Baseline characteristics were similar between trials and arms. Local relapse-free survival rates were not different (hazard-ratio [HR] 0.62; 95%confidence interval [CI] -0.38 to 1.62; P > 0.05); however, IMRT reduced the overall acute toxicity (RR 0.69, 95%CI 0.58 to 0.82; P < 0.00001) and acute moist desquamation (risk-ratio [RR] 0.71, 95%CI 0.60 to 0.82; P < 0.00001). Lymphedema and pneumonitis rates, and survival outcomes were not affected by IMRT. The 2-year telangiectasia rate was decreased with IMRT (RR 0.66, 95%CI 0.47 to 0.93; P = 0.02); however, edema, pain, pigmentation, or fibrosis remained unaffected. IMRT did not improve cosmesis. CONCLUSIONS: IMRT improved acute toxicity and lowered telangiectasia rates, without affecting oncological and aesthetic outcomes. SYSTEMATIC REVIEW REGISTRATION: This review was registered at Cochrane Database of Systematic Reviews 2013, Issue 3. Art. No.: CD010420. https://doi.org/10.1002/14651858.CD010420. |
| Document Type: | article |
| File Description: | electronic resource |
| Language: | English |
| ISSN: | 1806-9460 1516-3180 |
| Relation: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802025000100201&lng=en&tlng=en; http://www.scielo.br/pdf/spmj/v143n1/1806-9460-spmj-143-01-e2023324.pdf; https://doaj.org/toc/1806-9460 |
| DOI: | 10.1590/1516-3180.2023.0324.r1.03072024 |
| Access URL: | https://doaj.org/article/097663439eb74e02bfb00954ef953f54 |
| Accession Number: | edsdoj.097663439eb74e02bfb00954ef953f54 |
| Database: | Directory of Open Access Journals |
| ISSN: | 18069460 15163180 |
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| DOI: | 10.1590/1516-3180.2023.0324.r1.03072024 |
| Published in: | São Paulo Medical Journal |
| Language: | English |