Department of Radiation Oncology, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, NO. 519 Kunzhou Road, Kunming, Yunnan, 650101, PR China.
Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Yunnan Institute of Urology, No. 374 Dian-Mian Avenue, Kunming, Yunnan, 650101, PR China.
Cancer Radiother. 2022 Nov;26(8):1054-1063. doi: 10.1016/j.canrad.2022.04.003. Epub 2022 Aug 26.
In order to explore whether partial breast irradiation can replace hypofractionated whole breast irradiation and whether the former two are superior to conventional fractionated whole breast irradiation, we conducted a network meta-analysis based on the data from the latest randomized controlled trials to evaluate the efficacy of these radiotherapy modalities.
Data from eligible studies were analyzed to determine the published events for ipsilateral breast tumor recurrence, distant metastasis, total deaths, and non-breast cancer-related deaths. In the case of low or high heterogeneity, the fixed-effect or random-effect model was used for statistical analysis respectively. NMA was performed by using the node-splitting model for two-category data among three radiotherapies based on a Bayesian method.
A total of 23,418 patients were included in 16 studies. For ipsilateral breast tumor recurrence, both pairwise (OR=1.9; CI95%: 1.2 -2.8; p<0.05) and indirect (OR=1.7; CI95%: 1.2 -2.4; p<0.05) comparison of three radiotherapies by network meta-analysis showed that conventional fractionated whole breast irradiation was significantly better than partial breast irradiation. Indirect comparison of three radiotherapies by network meta-analysis showed that hypofractionated whole breast irradiation was significantly better than partial breast irradiation (OR=1.6; CI95%: 1.0 -2.5; p<0.05). Network and paired meta-analyses found no significant differences in other endpoints among the three radiotherapies.
Overall, this network meta-analysis showed that partial breast irradiation was related to the increase of ipsilateral breast tumor recurrence compared with hypofractionated or conventional fractionated whole breast irradiation in patients with early-stage breast cancer.
为了探讨部分乳房照射是否可以替代低分割全乳房照射，以及前两者是否优于常规分割全乳房照射，我们基于最新的随机对照试验数据进行了一项网络荟萃分析，以评估这些放疗方式的疗效。
分析了合格研究的数据，以确定同侧乳房肿瘤复发、远处转移、总死亡和非乳腺癌相关死亡的已发表事件。在存在低异质性或高异质性的情况下，分别使用固定效应或随机效应模型进行统计分析。对于三种放疗方法，基于贝叶斯方法，使用二分类数据的节点分割模型进行 NMA。
共有 16 项研究纳入了 23418 例患者。对于同侧乳房肿瘤复发，网络荟萃分析的直接（OR=1.9；95%CI：1.2-2.8；p<0.05）和间接（OR=1.7；95%CI：1.2-2.4；p<0.05）比较均表明，常规分割全乳房照射明显优于部分乳房照射。网络荟萃分析的三种放疗方法间接比较显示，低分割全乳房照射明显优于部分乳房照射（OR=1.6；95%CI：1.0-2.5；p<0.05）。网络和配对荟萃分析发现三种放疗方法在其他终点上无显著差异。
总体而言，这项网络荟萃分析表明，与低分割或常规分割全乳房照射相比，早期乳腺癌患者接受部分乳房照射与同侧乳房肿瘤复发风险增加相关。
