Valle Luca F, Agarwal Surbhi, Bickel Kathleen E, Herchek Haley A, Nalepinski David C, Kapadia Nirav S
The Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA.
Breast Cancer Res Treat. 2017 Apr;162(3):409-417. doi: 10.1007/s10549-017-4118-7. Epub 2017 Feb 3.
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.
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.
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 = 0%), locoregional failure, (n = 8 trials; RR 0.86; 95% CI 0.63-1.16, I = 0%), or survival (n = 4 trials; RR 1.00; 95% CI 0.85-1.17, I = 0%). ART was associated with significantly less acute toxicity (n = 5 trials; RR 0.36; 95% CI 0.21-0.62, I = 20%), but no difference in late cosmesis (RR 0.95; 95% CI 0.81-1.12, I = 54%).
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.
早期乳腺癌的保乳治疗（BCT）包括肿块切除术后进行全乳放疗，全乳放疗可采用标准分割放疗（SRT）或加速分割放疗（ART）。进行这项系统评价和荟萃分析以确定ART或SRT是否有任何益处。
我们检索了MEDLINE（1966 - 2014年）、Cochrane图书馆的所有七个数据库（1968 - 2014年）、EMBASE（1974 - 2014年）、clinicaltrials.gov、ISRCTN、世界卫生组织国际临床试验注册平台（WHO ICTRP）以及科学网核心合集（Web of Science Core Collection）中的会议摘要（1900 - 2014年）。纳入了对T1 - T2期和/或N1期乳腺癌或原位癌接受BCT的女性中SRT与ART进行比较的随机对照试验（RCT）。急性毒性的随访时间为30天，疾病控制和晚期毒性的随访时间为三年。
纳入了13项试验，共8189名参与者。在局部复发（n = 7项试验；RR 0.97；95% CI 0.78 - 1.19，I² = 0%）、区域复发（n = 8项试验；RR 0.86；95% CI 0.63 - 1.16，I² = 0%）或生存率（n = 4项试验；RR 1.00；95% CI 0.85 - 1.17，I² = 0%）方面未观察到差异。ART与显著更低的急性毒性相关（n = 5项试验；RR 0.36；95% CI 0.21 - 0.62，I² = 20%），但在晚期美容效果方面无差异（RR 0.95；95% CI 0.81 - 1.12，I² = 54%）。
与SRT相比，使用ART不会降低疾病控制效果或恶化长期美容效果，且可能降低急性放射毒性风险。
