%0 Journal Article
%A Haussmann, Jan
%A Budach, Wilfried
%A Corradini, Stefanie
%A Krug, David
%A Bölke, Edwin
%A Tamaskovics, Balint
%A Jazmati, Danny
%A Haussmann, Alexander
%A Matuschek, Christiane
%T Whole Breast Irradiation in Comparison to Endocrine Therapy in Early Stage Breast Cancer-A Direct and Network Meta-Analysis of Published Randomized Trials.
%J Cancers
%V 15
%N 17
%@ 2072-6694
%C Basel
%I MDPI
%M DKFZ-2023-01888
%P 4343
%D 2023
%X Multiple randomized trials have established adjuvant endocrine therapy (ET) and whole breast irradiation (WBI) as the standard approach after breast-conserving surgery (BCS) in early-stage breast cancer. The omission of WBI has been studied in multiple trials and resulted in reduced local control with maintained survival rates and has therefore been adapted as a treatment option in selected patients in several guidelines. Omitting ET instead of WBI might also be a valuable option as both treatments have distinctly different side effect profiles. However, the clinical outcomes of BCS + ET vs. BCS + WBI have not been formally analyzed.We performed a systematic literature review searching for randomized trials comparing BCS + ET vs. BCS + WBI in low-risk breast cancer patients with publication dates after 2000. We excluded trials using any form of chemotherapy, regional nodal radiation and mastectomy. The meta-analysis was performed using a two-step process. First, we extracted all available published event rates and the effect sizes for overall and breast-cancer-specific survival (OS, BCSS), local (LR) and regional recurrence, disease-free survival, distant metastases-free interval, contralateral breast cancer, second cancer other than breast cancer and mastectomy-free interval as investigated endpoints and compared them in a network meta-analysis. Second, the published individual patient data from the Early Breast Cancer Trialists' Collaborative Group (EBCTCG) publications were used to allow a comparison of OS and BCSS.We identified three studies, including a direct comparison of BCS + ET vs. BCS + WBI (n = 1059) and nine studies randomizing overall 7207 patients additionally to BCS only and BCS + WBI + ET resulting in a four-arm comparison. In the network analysis, LR was significantly lower in the BCS + WBI group in comparison with the BCS + ET group (HR = 0.62; CI-95
%K Network meta-analysis (Other)
%K breast cancer (Other)
%K de-escalation (Other)
%K endocrine therapy (Other)
%K radiotherapy (Other)
%F PUB:(DE-HGF)16
%9 Journal Article
%$ pmid:37686620
%2 pmc:PMC10487067
%R 10.3390/cancers15174343
%U https://inrepo02.dkfz.de/record/282895