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@ARTICLE{Haussmann:282895,
      author       = {J. Haussmann and W. Budach and S. Corradini and D. Krug and
                      E. Bölke and B. Tamaskovics and D. Jazmati and A.
                      Haussmann$^*$ and C. Matuschek},
      title        = {{W}hole {B}reast {I}rradiation in {C}omparison to
                      {E}ndocrine {T}herapy in {E}arly {S}tage {B}reast
                      {C}ancer-{A} {D}irect and {N}etwork {M}eta-{A}nalysis of
                      {P}ublished {R}andomized {T}rials.},
      journal      = {Cancers},
      volume       = {15},
      number       = {17},
      issn         = {2072-6694},
      address      = {Basel},
      publisher    = {MDPI},
      reportid     = {DKFZ-2023-01888},
      pages        = {4343},
      year         = {2023},
      abstract     = {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; $CI-95\%:$
                      0.42-0.92; p = 0.019). We did not find any differences in OS
                      (HR = 0.93; $CI-95\%:$ 0.53-1.62; p = 0.785) and BCSS (OR =
                      1.04; $CI-95\%:$ 0.45-2.41; p = 0.928). Further, we found a
                      lower distant metastasis-free interval, a higher rate of
                      contralateral breast cancer and a reduced mastectomy-free
                      interval in the BCS + WBI-arm. Using the EBCTCG data, OS and
                      BCSS were not significantly different between BCS + ET and
                      BCS + WBI after 10 years (OS: OR = 0.85; $CI-95\%:$
                      0.59-1.22; p = 0.369) (BCSS: OR = 0.72; $CI-95\%:$
                      0.38-1.36; p = 0.305).Evidence from direct and indirect
                      comparison suggests that BCS + WBI might be an equivalent
                      de-escalation strategy to BCS + ET in low-risk breast
                      cancer. Adverse events and quality of life measures have to
                      be further compared between these approaches.},
      keywords     = {Network meta-analysis (Other) / breast cancer (Other) /
                      de-escalation (Other) / endocrine therapy (Other) /
                      radiotherapy (Other)},
      cin          = {C110},
      ddc          = {610},
      cid          = {I:(DE-He78)C110-20160331},
      pnm          = {313 - Krebsrisikofaktoren und Prävention (POF4-313)},
      pid          = {G:(DE-HGF)POF4-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:37686620},
      pmc          = {pmc:PMC10487067},
      doi          = {10.3390/cancers15174343},
      url          = {https://inrepo02.dkfz.de/record/282895},
}