Highlights
- •DCIS patients treated with accelerated partial breast irradiation has comparable outcomes to whole breast irradiation.
- •Better safety outcomes in accelerated partial breast irradiation.
- •Significantly less recurrence rate among DCIS patients classified as Suitable in 2017 ASTRO Consensus.
Abstract
Background
The natural history of DCIS may not be progression to invasive breast cancer (IBC).
Accelerated partial breast irradiation (APBI) has emerged as an alternative to whole
breast radiotherapy (WBRT). The purpose of this study was to assess the impact of
APBI on DCIS patients.
Materials and methods
Eligible studies from 2012 to 2022 were identified in PubMed, Cochrane Library, ClinicalTrials,
and ICTRP. A meta-analysis was done comparing recurrence rates, breast-related mortality
rates, and adverse events of APBI versus WBRT. A subgroup analysis of 2017 ASTRO Guidelines
“Suitable” and “Unsuitable” groups was performed. Forest plots and quantitative analysis
were done.
Results
Six studies were eligible (3 on APBI versus WBRT, 3 on APBI suitability). All had
a low risk of bias and publication bias. The cumulative incidence was the following
for APBI and WBRT respectively: IBTR was 5.7% and 6.3% with odds ratio of 1.09, 95%
CI [0.84, 1.42], mortality rate was 4.9% and 5.05%, and adverse events was 48.87%
and 69.63%. All had no statistical significance between groups. Adverse events were
found to favor the APBI arm. Recurrence rate was significantly less in the Suitable
group with an odds ratio 2.69, 95% CI [1.56, 4.67], favoring it over the Unsuitable
group.
Conclusion
APBI was comparable to WBRT in terms of recurrence rate, breast cancer-related mortality
rate, and adverse events. APBI was not inferior to WBRT and showed better safety in
terms of skin toxicity. Patients classified as suitable for APBI had significantly
lesser recurrence rate.
Keywords
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Article info
Publication history
Published online: March 06, 2023
Accepted:
March 6,
2023
Received in revised form:
February 6,
2023
Received:
November 12,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
