作为早期乳腺癌的一种治疗选择，术中放疗并非全乳放疗的更好替代方案。
Intraoperative Radiotherapy Is Not a Better Alternative to Whole Breast Radiotherapy as a Therapeutic Option for Early-Stage Breast Cancer.
作者信息
Wang Linwei, Sun Min, Yang Shuailong, Chen Yuanyuan, Li Tian
机构信息
Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors/Hubei Cancer Clinical Study Center, Zhongnan Hospital, Wuhan University, Wuhan, China.
Department of General Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China.
出版信息
Front Oncol. 2021 Dec 16;11:737982. doi: 10.3389/fonc.2021.737982. eCollection 2021.
OBJECTIVE
Intraoperative radiotherapy (IORT) in early-stage breast cancer has been studied over the years. However, it has not been demonstrated whether IORT is more suitable as a therapeutic option for early-stage breast cancer than whole breast radiotherapy (WBRT). Therefore, we performed a meta-analysis to compare the efficacy and safety of IORT to those of WBRT as therapeutic options for early-stage breast cancer patients receiving breast-conserving surgery (INPLASY2020120008).
METHODS
PubMed, Embase, and Cochrane Library databases were searched from inception to October 2021. Computerized and manual searches were adopted to identify eligible randomized control trials from online databases. Risk ratio (RR) and 95% confidence intervals (CI) were calculated by random-effect models to assess the relative risk. Potential publication bias was quantified by Begg's and Egger's tests.
RESULTS
Based on our inclusion criteria, 10 randomized control trials involving 5,698 patients were included in this meta-analysis. This meta-analysis showed that the IORT group was associated with a higher local recurrence risk (RR = 2.111, 95% CI, 1.130-3.943, = 0.0191), especially in the long-term follow-up subgroup or published after 2020 subgroup or Caucasian subgroup (RR = 2.404, 95% CI, 1.183-4.885, = 0.0154). Subgroup analysis showed that the IORT group had a higher recurrence risk than the WBRT group in the polycentric randomized controlled trial subgroup (RR = 1.213, 95% CI, 1.030-1.428, = 0.0204). Pooled analysis showed that there was no statistically significant difference in overall survival, recurrence-free survival, distant metastasis-free survival, and cancer-specific survival between IORT and WBRT groups. Additionally, the risk of skin toxicity was reduced, but the incidences of fat toxicity, edema, and scar calcification were significantly increased in the patients who underwent IORT in comparison to those who underwent WBRT.
CONCLUSION
This meta-analysis revealed that IORT was not a better alternative to WBRT. More large-scale and well-designed clinical trials with longer follow-up periods are encouraged to further investigate the value of IORT.
SYSTEMATIC REVIEW REGISTRATION
目的
多年来一直在研究早期乳腺癌的术中放疗（IORT）。然而，尚未证实IORT作为早期乳腺癌的治疗选择是否比全乳放疗（WBRT）更合适。因此，我们进行了一项荟萃分析，以比较IORT与WBRT作为接受保乳手术的早期乳腺癌患者治疗选择的疗效和安全性（INPLASY2020120008）。
方法
检索了从数据库建立至2021年10月的PubMed、Embase和Cochrane图书馆数据库。采用计算机检索和手动检索从在线数据库中识别符合条件的随机对照试验。采用随机效应模型计算风险比（RR）和95%置信区间（CI）以评估相对风险。通过Begg检验和Egger检验对潜在的发表偏倚进行量化。
结果
根据我们的纳入标准，本荟萃分析纳入了10项涉及5698例患者的随机对照试验。该荟萃分析表明，IORT组的局部复发风险更高（RR = 2.111，95% CI，1.130 - 3.943，P = 0.0191），尤其是在长期随访亚组或2020年后发表的亚组或白种人亚组中（RR = 2.404，95% CI，1.183 - 4.885，P = 0.0154）。亚组分析表明，在多中心随机对照试验亚组中，IORT组的复发风险高于WBRT组（RR = 1.213，95% CI，1.030 - 1.428，P = 0.0204）。汇总分析表明，IORT组和WBRT组在总生存期、无复发生存期、无远处转移生存期和癌症特异性生存期方面无统计学显著差异。此外，IORT组患者的皮肤毒性风险降低，但与接受WBRT的患者相比，脂肪毒性、水肿和瘢痕钙化的发生率显著增加。
结论
本荟萃分析表明，IORT并非WBRT的更好替代方案。鼓励开展更多大规模、设计良好且随访期更长的临床试验，以进一步研究IORT的价值。
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