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| Home > Publications database > Whole Breast Irradiation in Comparison to Endocrine Therapy in Early Stage Breast Cancer-A Direct and Network Meta-Analysis of Published Randomized Trials. > print |
| Home > Publications database > Whole Breast Irradiation in Comparison to Endocrine Therapy in Early Stage Breast Cancer-A Direct and Network Meta-Analysis of Published Randomized Trials. > print |
| 001 | 282895 | ||
| 005 | 20240229155047.0 | ||
| 024 | 7 | _ | |a 10.3390/cancers15174343 |2 doi |
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| 082 | _ | _ | |a 610 |
| 100 | 1 | _ | |a Haussmann, Jan |b 0 |
| 245 | _ | _ | |a Whole Breast Irradiation in Comparison to Endocrine Therapy in Early Stage Breast Cancer-A Direct and Network Meta-Analysis of Published Randomized Trials. |
| 260 | _ | _ | |a Basel |c 2023 |b MDPI |
| 336 | 7 | _ | |a article |2 DRIVER |
| 336 | 7 | _ | |a Output Types/Journal article |2 DataCite |
| 336 | 7 | _ | |a Journal Article |b journal |m journal |0 PUB:(DE-HGF)16 |s 1695103604_15142 |2 PUB:(DE-HGF) |
| 336 | 7 | _ | |a ARTICLE |2 BibTeX |
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| 336 | 7 | _ | |a Journal Article |0 0 |2 EndNote |
| 520 | _ | _ | |a 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. |
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| 650 | _ | 7 | |a Network meta-analysis |2 Other |
| 650 | _ | 7 | |a breast cancer |2 Other |
| 650 | _ | 7 | |a de-escalation |2 Other |
| 650 | _ | 7 | |a endocrine therapy |2 Other |
| 650 | _ | 7 | |a radiotherapy |2 Other |
| 700 | 1 | _ | |a Budach, Wilfried |b 1 |
| 700 | 1 | _ | |a Corradini, Stefanie |0 0000-0001-8709-7252 |b 2 |
| 700 | 1 | _ | |a Krug, David |0 0000-0001-8811-5416 |b 3 |
| 700 | 1 | _ | |a Bölke, Edwin |0 0000-0001-9112-1024 |b 4 |
| 700 | 1 | _ | |a Tamaskovics, Balint |0 0000-0002-2533-0167 |b 5 |
| 700 | 1 | _ | |a Jazmati, Danny |b 6 |
| 700 | 1 | _ | |a Haussmann, Alexander |0 P:(DE-He78)6911b891e4f82e142d099f0aa249c37d |b 7 |u dkfz |
| 700 | 1 | _ | |a Matuschek, Christiane |b 8 |
| 773 | _ | _ | |a 10.3390/cancers15174343 |g Vol. 15, no. 17, p. 4343 - |0 PERI:(DE-600)2527080-1 |n 17 |p 4343 |t Cancers |v 15 |y 2023 |x 2072-6694 |
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