Marta Gustavo Nader, Barrett Jessica, Porfirio Gustavo José Martiniano, Martimbianco Ana Luiza Cabrera, Bevilacqua José Luiz Barbosa, Poortmans Philip, Riera Rachel
Department of Radiation Oncology - Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91, Sao Paulo, SP 01308-050, Brazil.
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.
Rep Pract Oncol Radiother. 2019 Mar-Apr;24(2):165-174. doi: 10.1016/j.rpor.2019.01.009. Epub 2019 Feb 15.
This systematic review was conducted to compare the effectiveness of different accelerated partial breast irradiation (APBI) techniques for the treatment of breast cancer patients.
Numerous (APBI) techniques are available for clinical practice.
Systematic 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.
Ten 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.
Based 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.
进行这项系统评价以比较不同的加速部分乳腺照射（APBI）技术治疗乳腺癌患者的有效性。
有多种APBI技术可用于临床实践。
对APBI与全乳照射（WBI）的随机对照试验进行系统评价。提取APBI研究的数据进行分析。采用间接比较来比较不同的APBI技术。
10项研究符合纳入标准。共纳入4343例患者，大多数患者肿瘤分期为T1 - T2且N0。关于APBI技术，6项试验采用外照射放疗；1项采用术中电子线照射；1项采用术中低能光子照射；1项采用近距离放疗；1项采用外照射放疗或近距离放疗。在APBI技术之间，与5年局部控制率和5年总生存率相关的间接比较无显著差异。
基于间接比较，在已发表的将WBI与APBI进行正式比较的临床试验中，不同APBI技术的临床结局未观察到差异。然而，宽泛的置信区间和较高的不一致风险妨碍得出可靠结论。需要进一步开展比较不同APBI技术的直接头对头临床试验来证实我们的发现。使用个体参与者数据和/或基于人群研究/登记处的真实数据比较不同技术的研究也可能提供更可靠的结果。
