Center of Vascular-Thyroid-Breast Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Breast J. 2023 Jul 3;2023:9035266. doi: 10.1155/2023/9035266. eCollection 2023.
Intraoperative radiotherapy (IORT) is a novel promising technology that may replace external beam radiation therapy (EBRT) as boost for patients receiving breast-conserving surgery. To better evaluate the efficacy of IORT using low-kilovoltage (low-kV) X-rays as boost, we presented this meta-analysis according to the PRISMA checklist.
Studies reported survival outcomes of intraoperative radiation using low-kilovoltage X-rays system (Intrabeam®, Carl Zeiss Meditec, Dublin, CA, USA) as boost were identified through electronic bibliographic database: PUBMED. The meta-analysis module in Stata (16.0) is used to pool the studies. A Poisson regression model is used to predict a 5-year local recurrence rate.
Twelve studies including 3006 cases were included in the final analysis, with a median follow-up of 55 months weighted by sample size. The pooled local recurrence rate is 0.39% per person-year (95% CI: 0.15%-0.71%), with a low degree of heterogeneity ( = 0%). The predicted 5-year local recurrence rate was 3.45%. No difference in pooled local recurrence rate was found between non-neoadjuvant patients studies and neoadjuvant patients studies (0.41% per person-year vs. 0.58% per person-year, = 0.580).
This study shows that low-kV IORT is an effective method as boost in breast cancer patients, with a low pooled local recurrence rate and low predicted 5-year local recurrence rate. Besides, no difference in the local recurrence rate was found between non-neoadjuvant patients studies and neoadjuvant patients studies. Low-kV IORT boost may be a promising alternative to EBRT boost in the future, which is being tested in the ongoing TARGIT-B trial.
术中放疗（IORT）是一种有前途的新技术，可能会替代乳腺癌保乳手术后的外部束放射治疗（EBRT）。为了更好地评估使用低千伏（low-kV）X 射线作为增敏的 IORT 的疗效，我们根据 PRISMA 清单进行了这项荟萃分析。
通过电子文献数据库 PUBMED 确定了使用低千伏 X 射线系统（Intrabeam®，德国卡尔蔡司 Meditec 公司，加利福尼亚州都柏林）进行术中放疗的生存结果研究。使用 Stata（16.0）中的荟萃分析模块对研究进行汇总。使用泊松回归模型预测 5 年局部复发率。
最终分析纳入了 12 项研究，共 3006 例患者，根据样本量加权的中位随访时间为 55 个月。汇总的局部复发率为 0.39%/人年（95%CI：0.15%-0.71%），异质性较低（ = 0%）。预测的 5 年局部复发率为 3.45%。非新辅助患者研究和新辅助患者研究的局部复发率无差异（0.41%/人年比 0.58%/人年， = 0.580）。
本研究表明，低千伏 IORT 是乳腺癌患者增敏的有效方法，局部复发率低，预测的 5 年局部复发率低。此外，非新辅助患者研究和新辅助患者研究的局部复发率无差异。低千伏 IORT 增敏可能是未来 EBRT 增敏的一种有前途的替代方法，目前正在进行的 TARGIT-B 试验正在对此进行测试。
