Weighing partial vs whole breast irradiation for early breast cancer

  • Korzets Y & al.
  • Breast Cancer Res Treat
  • 30 Mar 2019

  • curated by Miriam Davis, PhD
  • Univadis Clinical Summaries
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Takeaway

  • Partial breast irradiation (PBI) in women with early breast cancer is associated with greater 5-year risk of local recurrence and greater toxicity than whole breast irradiation (WBI), but PBI carries reduced risk of death without tumor recurrence.

Why this matters

  • While WBI remains the standard of care, PBI using external beam radiation therapy may be optimal for smaller, hormone receptor-positive tumors without nodal involvement.

Study design

  • Meta-analysis of 9 randomized controlled trials (n=14,514) after search of MEDLINE.
  • Funding: None disclosed.

Key results

  • PBI (vs WBI) was associated with 5-year:
    • Higher risk of local recurrence (OR, 1.69; P<.001>
    • Greater toxicity (fat necrosis: OR, 1.72; P=.002; and marginally more breast pain: OR, 1.17; P=.07);
    • Lower odds of death without tumor recurrence (OR, 0.55; P<.001>
    • Marginally improved OS (OR, 0.84; P=.06); and
    • Marginally worse cosmetic outcome (OR, 1.23; P=.06).
  • In subgroup analysis:
    • Nodal involvement (vs non-nodal) was associated with greater odds of local recurrence (P=.027); and
    • Larger tumor size (vs smaller size) was associated with less improvement from death without tumor recurrence (P=.011) and shorter OS (P=.019).

Limitations

  • Small number of trials.
  • Only 1 database searched.
  • Longer duration than 5 years may be needed.