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Wujanto C, Lee CC, Meng T, Ooi KH, Tan TH, Koh WY, Tseng MSF, Koh V, Yeoh T, Leong YH, Chia D, Ng IW, Ho F, Tey J, Soon YY. Adjuvant Breast Radiation Therapy for Early-Stage Breast Cancer or Ductal Carcinoma In-Situ in the Breast: A Systematic Review and Network Meta-Analysis of Randomized Trials. Int J Radiat Oncol Biol Phys 2023; 117:e214. [PMID: 37784885 DOI: 10.1016/j.ijrobp.2023.06.1106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) For selected patients with early-stage breast cancer (BC) or ductal carcinoma in-situ (DCIS) in the breast, adjuvant breast radiation therapy (RT) approaches include partial breast irradiation (PBI), altered fractionation (AF) whole breast irradiation (WBI) or tumor bed boost (TBB). However, it is unclear which is the optimal approach. This study aims to compare the effects of different PBI, AF-WBI and TBB options on ipsilateral breast tumor recurrence (IBTR), overall survival (OS) and patient reported cosmesis (PRC) outcomes. MATERIALS/METHODS We searched various biomedical electronic databases for eligible randomized trials (RCTs) from date of inception to January 2023. We constructed six separate random effects frequentist network meta-analyses (NMA) to compare the effects of various PBI options using WBI as the reference; various AF-WBI options using conventional fractionated (CF) WBI as the reference and various TBB options using no TBB as the reference on IBTR and OS. The GRADE approach was used to assess the certainty of evidence. The synthesis without meta-analysis approach was pre-specified for evaluation of PRC in anticipation of various assessment and reporting methods. RESULTS We included 34 RCTs comprising 49,899 participants and 11 treatment options. Evidence suggests that accelerated PBI (Hazard Ratio (HR) 1.36 (95% confidence interval (CI) 0.77 - 2.41, moderate certainty), moderately hypofractionated (MHF) PBI (HR 1.38 (0.60 - 3.19), moderate certainty) and intraoperative PBI (HR 1.47 (0.81 - 2.68), low certainty) was associated with a modest but not statistically significant increase in the hazards for IBTR when compared to WBI. There was moderate certainty evidence that there were no significant differences among the accelerated ultra-hypo fractionated (AUHF) WBI (HR 0.76 (0.50 - 1.14)), MHF-WBI (HR 0.99 (0.84 - 1.16)) or UHF-WBI (HR (1.35 (0.47 - 3.92)) when compared with CF-WBI for IBTR. The effects of sequential TBB (seqTBB) (HR 0.61 (0.52 - 0.70), high certainty) and simultaneous integrated TBB (simTBB) (HR 0.77 (0.55 - 1.09), moderate certainty) on IBTR were similar when compared to no TBB. There were no significant differences in OS between PBI options and WBI, AF-WBI options and CF-WBI, TBB options and no TBB. Among the PBI vs WBI trials, MHF-PBI and APBI may be associated with fewer adverse PRC events. Among the AF-WBI vs CF-WBI trials, half of the included trials reported fewer adverse PRC events with MHF-WBI. SeqTBB and simTBB had similar adverse PRC outcome. CONCLUSION There were no significant differences among the PBI, AF-WBI and TBB options for IBTR and OS. PBI and AF-WBI may be associated with less adverse PRC events compared with WBI and CF-WBI respectively. There was no evidence to suggest a difference between seqTBB and simTBB for PRC outcome. This study is registered with PROSPERO CRD 42021245074.
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Affiliation(s)
- C Wujanto
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - C C Lee
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - T Meng
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - K H Ooi
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - T H Tan
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - W Y Koh
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - M S F Tseng
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - V Koh
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - T Yeoh
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - Y H Leong
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - D Chia
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - I W Ng
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - F Ho
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - J Tey
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - Y Y Soon
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
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Lee S, Yip P, Wong A, Ng F, Koh V, Wong L, Lee F, Mamon H. PO-1306 Impacts and consequences of spleen irradiation after adjuvant chemoradiation for stomach cancer. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03270-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Ooi K, Koh W, Ho F, Tseng M, Tan T, Koh V, Leong Y, Chia D, Tey J, Soon Y. Efficacy and Safety of Adjuvant Breast Radiation Therapy for Patients With Early-Stage Breast Cancer: A Systematic Review and Network Meta-Analysis. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ngoi N, Heong V, Kumarakulasinghe N, Phyu P, Peh E, Lim S, Lim Y, Tang J, Choo B, Koh V, Ilancheran A, Low J, Ng J, Thian Y, Tan D. Phase I study of low dose whole abdominal radiation therapy (LDWART) in combination with weekly paclitaxel (wP) for platinum resistant ovarian cancer (PROC). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz250.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Tang J, Koh V, Leong Y, Buhari S. PO-1013: Using A Decision Board To Evaluate Patient’s Choice Of Either Ebrt Or Multicatheter APBI. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31323-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Teoh CS, Aquino MC, Loon SC, Chew P, Koh V. Comparing the use of phacoemulsification and combined surgery in angle-closure glaucoma. Expert Review of Ophthalmology 2017. [DOI: 10.1080/17469899.2017.1379901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- CS Teoh
- Department of Ophthalmology, National University Hospital of Singapore, Singapore, Singapore
| | - MC Aquino
- Department of Ophthalmology, National University Hospital of Singapore, Singapore, Singapore
| | - SC Loon
- Department of Ophthalmology, National University Hospital of Singapore, Singapore, Singapore
| | - P Chew
- Department of Ophthalmology, National University Hospital of Singapore, Singapore, Singapore
| | - V Koh
- Department of Ophthalmology, National University Hospital of Singapore, Singapore, Singapore
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Choo B, Koh V, Tang J, Low J, Stephenson M, Cheong DH, Laurens E, Totman J, Ng JY, Roy S. 324P Radiation response assessment by hybrid positron emission tomography/magnetic resonance imaging for cervical cancer treatment. Ann Oncol 2016. [DOI: 10.1016/s0923-7534(21)00482-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Choo B, Koh V, Tang J, Low J, Stephenson M, Cheong DH, Laurens E, Totman J, Ng JY, Roy S. 324P Radiation response assessment by hybrid positron emission tomography/magnetic resonance imaging for cervical cancer treatment. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw585.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Goh M, Chaung J, Koh V, Sundar G. Spectrum and outcomes of open globe injuries presenting to a tertiary Eye Centre in Singapore. Acta Ophthalmol 2016. [DOI: 10.1111/j.1755-3768.2016.0378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Tang J, Tan P, Koh V, Buhari S. PO-1003: Comparing dosimetric outcomes of two different insertion methods for multicatheter breast brachytherapy. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)31121-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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