Intensity-modulated radiation therapy for early-stage breast cancer: a systematic review and meta-analysis
ABSTRACT BACKGROUND: Radiation therapy (RT) is a standard treatment for non-metastatic breast cancer and is associated with acute and late toxicities. Intensity-modulated RT (IMRT) may decrease toxicity and is convenient for patients. OBJECTIVES: To assess the efficacy and safety of IMRT in women...
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Associação Paulista de Medicina
2024-12-01
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| Series: | São Paulo Medical Journal |
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| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802025000100201&lng=en&tlng=en |
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| author | Samir Abdallah Hanna Bruna Salani Mota Fabio Ynoe de Moraes Gustavo Nader Marta Heloísa de Andrade Carvalho Rachel Riera |
| author_facet | Samir Abdallah Hanna Bruna Salani Mota Fabio Ynoe de Moraes Gustavo Nader Marta Heloísa de Andrade Carvalho Rachel Riera |
| author_sort | Samir Abdallah Hanna |
| collection | DOAJ |
| description | ABSTRACT BACKGROUND: Radiation therapy (RT) is a standard treatment for non-metastatic breast cancer and is associated with acute and late toxicities. Intensity-modulated RT (IMRT) may decrease toxicity and is convenient for patients. OBJECTIVES: To assess the efficacy and safety of IMRT in women with early stage breast cancer. DESIGN AND SETTING: Systematic review study; Multi-institutional centers. METHODS: Seven databases were searched. Randomized controlled trials (RCT) comparing IMRT with any “non-IMRT” strategies were included. Primary outcomes were local control and acute toxicity. Cochrane Handbook was use to plan and conduct the review, and PRISMA 2020 was used to report results. RESULTS: Five RCT involving 2,556 women (n = 1,283 IMRT; n = 1,274 control arm) were included. Baseline characteristics were similar between trials and arms. Local relapse-free survival rates were not different (hazard-ratio [HR] 0.62; 95%confidence interval [CI] -0.38 to 1.62; P > 0.05); however, IMRT reduced the overall acute toxicity (RR 0.69, 95%CI 0.58 to 0.82; P < 0.00001) and acute moist desquamation (risk-ratio [RR] 0.71, 95%CI 0.60 to 0.82; P < 0.00001). Lymphedema and pneumonitis rates, and survival outcomes were not affected by IMRT. The 2-year telangiectasia rate was decreased with IMRT (RR 0.66, 95%CI 0.47 to 0.93; P = 0.02); however, edema, pain, pigmentation, or fibrosis remained unaffected. IMRT did not improve cosmesis. CONCLUSIONS: IMRT improved acute toxicity and lowered telangiectasia rates, without affecting oncological and aesthetic outcomes. SYSTEMATIC REVIEW REGISTRATION: This review was registered at Cochrane Database of Systematic Reviews 2013, Issue 3. Art. No.: CD010420. https://doi.org/10.1002/14651858.CD010420. |
| format | Article |
| id | doaj-art-097663439eb74e02bfb00954ef953f54 |
| institution | Kabale University |
| issn | 1806-9460 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Associação Paulista de Medicina |
| record_format | Article |
| series | São Paulo Medical Journal |
| spelling | doaj-art-097663439eb74e02bfb00954ef953f542025-01-07T07:37:20ZengAssociação Paulista de MedicinaSão Paulo Medical Journal1806-94602024-12-01143110.1590/1516-3180.2023.0324.r1.03072024Intensity-modulated radiation therapy for early-stage breast cancer: a systematic review and meta-analysisSamir Abdallah Hannahttps://orcid.org/0000-0002-1976-0662Bruna Salani Motahttps://orcid.org/0000-0001-9567-1066Fabio Ynoe de Moraeshttps://orcid.org/0000-0003-3407-9215Gustavo Nader Martahttps://orcid.org/0000-0002-2220-4296Heloísa de Andrade Carvalhohttps://orcid.org/0000-0003-0979-7768Rachel Rierahttps://orcid.org/0000-0002-9522-1871ABSTRACT BACKGROUND: Radiation therapy (RT) is a standard treatment for non-metastatic breast cancer and is associated with acute and late toxicities. Intensity-modulated RT (IMRT) may decrease toxicity and is convenient for patients. OBJECTIVES: To assess the efficacy and safety of IMRT in women with early stage breast cancer. DESIGN AND SETTING: Systematic review study; Multi-institutional centers. METHODS: Seven databases were searched. Randomized controlled trials (RCT) comparing IMRT with any “non-IMRT” strategies were included. Primary outcomes were local control and acute toxicity. Cochrane Handbook was use to plan and conduct the review, and PRISMA 2020 was used to report results. RESULTS: Five RCT involving 2,556 women (n = 1,283 IMRT; n = 1,274 control arm) were included. Baseline characteristics were similar between trials and arms. Local relapse-free survival rates were not different (hazard-ratio [HR] 0.62; 95%confidence interval [CI] -0.38 to 1.62; P > 0.05); however, IMRT reduced the overall acute toxicity (RR 0.69, 95%CI 0.58 to 0.82; P < 0.00001) and acute moist desquamation (risk-ratio [RR] 0.71, 95%CI 0.60 to 0.82; P < 0.00001). Lymphedema and pneumonitis rates, and survival outcomes were not affected by IMRT. The 2-year telangiectasia rate was decreased with IMRT (RR 0.66, 95%CI 0.47 to 0.93; P = 0.02); however, edema, pain, pigmentation, or fibrosis remained unaffected. IMRT did not improve cosmesis. CONCLUSIONS: IMRT improved acute toxicity and lowered telangiectasia rates, without affecting oncological and aesthetic outcomes. SYSTEMATIC REVIEW REGISTRATION: This review was registered at Cochrane Database of Systematic Reviews 2013, Issue 3. Art. No.: CD010420. https://doi.org/10.1002/14651858.CD010420.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802025000100201&lng=en&tlng=enIntensity-modulated radiotherapyBreast neoplasmsAdjuvant radiotherapyBreast cancerBreast-conservative treatmentPostoperative radiotherapyAcute toxicityLate toxicity |
| spellingShingle | Samir Abdallah Hanna Bruna Salani Mota Fabio Ynoe de Moraes Gustavo Nader Marta Heloísa de Andrade Carvalho Rachel Riera Intensity-modulated radiation therapy for early-stage breast cancer: a systematic review and meta-analysis São Paulo Medical Journal Intensity-modulated radiotherapy Breast neoplasms Adjuvant radiotherapy Breast cancer Breast-conservative treatment Postoperative radiotherapy Acute toxicity Late toxicity |
| title | Intensity-modulated radiation therapy for early-stage breast cancer: a systematic review and meta-analysis |
| title_full | Intensity-modulated radiation therapy for early-stage breast cancer: a systematic review and meta-analysis |
| title_fullStr | Intensity-modulated radiation therapy for early-stage breast cancer: a systematic review and meta-analysis |
| title_full_unstemmed | Intensity-modulated radiation therapy for early-stage breast cancer: a systematic review and meta-analysis |
| title_short | Intensity-modulated radiation therapy for early-stage breast cancer: a systematic review and meta-analysis |
| title_sort | intensity modulated radiation therapy for early stage breast cancer a systematic review and meta analysis |
| topic | Intensity-modulated radiotherapy Breast neoplasms Adjuvant radiotherapy Breast cancer Breast-conservative treatment Postoperative radiotherapy Acute toxicity Late toxicity |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802025000100201&lng=en&tlng=en |
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