Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, No.126 Xiantai Street, 130033, Changchun, Jilin, China.
Sci Rep. 2024 Sep 27;14(1):22283. doi: 10.1038/s41598-024-73627-x.
To evaluate the efficacy and safety of four techniques of partial breast irradiation (PBI) including interstitial brachytherapy (ISBT), balloon-based brachytherapy (BBT), Intraoperative radiotherapy (IORT) and three-dimensional conformal radiotherapy (3DCRT) in the treatment for early-stage breast cancer patients after breast-conserving surgery. A systematic search was performed according to the Preferred Reporting Items of Systematic Reviews and Meta-analyses (PRISMA) guidelines using the PubMed, Embase, Cochrane Library and Web of Science databases. The inclusion criteria were clinical trials and observational studies that reported on outcome measures of principal PBI techniques. The methodological quality of the included research data was assessed using bias risk assessment tool with the Methodological Index for Non-Randomized Studies (MINORS), and the research information were analyzed using data analysis software. Clinical studies were collected from the earliest available date until September 2023. Fifty-one studies were included, with a total sample size of 7708. The results of network meta-analysis (NMA) showed that ISBT can lower the local recurrence (SUCRA: 73.8%). In terms of reducing distant metastasis, 3DCRT may be the best choice (SUCRA: 52.5%). And IORT has the highest 5-year overall survival (SUCRA: 90%). Furthermore, ISBT also has the advantages of lowest risk with fat necrosis (SUCRA: 72.5%), infection (SUCRA: 78.3%) and breast pain (SUCRA: 86.2%). BBT may be the optimal solution for fibrosis (SUCRA: 76.9%) and hyperpigmentation (SUCRA: 66.7%). 3DCRT has lower incidence of telangiectasia (SUCRA: 56.7%) and better cosmetic result (SUCRA: 85%). Postoperative PBI treatment using ISBT after breast-conserving surgery in patients with early-stage breast cancer may be a more valuable choice based on the treatment efficacy and is associated with fewer late side-effects. Large-scale, prospective, long-term studies are warranted to clarify the role of different PBI techniques in selected patients.
评价四种局部乳腺照射(PBI)技术,包括间质近距离放疗(ISBT)、球囊式近距离放疗(BBT)、术中放疗(IORT)和三维适形放疗(3DCRT),在保乳手术后早期乳腺癌患者中的疗效和安全性。按照系统评价和荟萃分析的首选报告项目(PRISMA)指南,通过 PubMed、Embase、Cochrane 图书馆和 Web of Science 数据库进行系统检索。纳入标准是报告主要 PBI 技术的结局测量的临床试验和观察性研究。使用非随机研究方法学指数(MINORS)偏倚风险评估工具评估纳入研究数据的方法学质量,并使用数据分析软件分析研究信息。临床研究从最早可获得的日期收集到 2023 年 9 月。共纳入 51 项研究,总样本量为 7708 例。网络荟萃分析(NMA)的结果表明,ISBT 可降低局部复发率(SUCRA:73.8%)。在降低远处转移方面,3DCRT 可能是最佳选择(SUCRA:52.5%)。IORT 具有最高的 5 年总生存率(SUCRA:90%)。此外,ISBT 在脂肪坏死(SUCRA:72.5%)、感染(SUCRA:78.3%)和乳房疼痛(SUCRA:86.2%)方面的风险也最低。BBT 在纤维化(SUCRA:76.9%)和色素沉着(SUCRA:66.7%)方面可能是最佳选择。3DCRT 在放射性毛细血管扩张(SUCRA:56.7%)和美容效果(SUCRA:85%)方面的发生率较低。基于治疗效果,保乳手术后早期乳腺癌患者采用 ISBT 进行术后 PBI 治疗可能是更有价值的选择,且与较少的晚期副作用相关。需要开展大规模、前瞻性、长期研究,以明确不同 PBI 技术在特定患者中的作用。
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