Comparing Hypofractionated With Conventional Fractionated Radiotherapy After Breast-Conserving Surgery for Early Breast Cancer: A Meta-Analysis of Randomized Controlled Trials

Gu, Liang; Dai, Wei; Fu, Rongrong; Lu, Hongzhou; Shen, Jingyi; Shi, Yetan; Zhang, Mengting; Jiang, Ke; Wu, Feng

doi:10.3389/fonc.2021.753209

Cited by 16 publications

(8 citation statements)

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“…The results of this study showed that the metabolism of the mammary glands gradually decreased over 5 years after irradiation, and it became significantly lower than that before irradiation. Although there have been reports of breast atrophy and lactation disorders after irradiation [2,3], this is the first report of quantitative evaluation of metabolic changes in the mammary gland after irradiation. Pathological changes in the mammary gland after irradiation have been reported as epithelial atrophy, fat necrosis, fibrosis of terminal duct lobular unit, and fibroblastic intimal thickening of arteries and veins of various sizes [4][5][6].…”

Section: Discussionmentioning

confidence: 86%

“…Adjuvant whole-breast irradiation (WBI) after lumpectomy has been the standard treatment for most patients with early-stage breast cancer [1]. Severe toxicity after WBI is rare, but moderate late adverse events such as induration, edema, breast atrophy have been reported [2]. Radiation therapy is known to impair lactation by reducing the metabolism and function of the mammary glands [3].…”

Section: Introductionmentioning

confidence: 99%

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Quantitative evaluation of radiation-induced metabolic changes in the ipsilateral breast by FDG-PET/CT

Hama

2022

Imaging

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Background and aimThere are no reports of quantitative evaluation of metabolic changes in the mammary gland after radiation therapy. The purpose of this study was to investigate metabolic changes in the ipsilateral mammary gland after radiation therapy and to evaluate the late radiation effects.Patients and methodsMetabolic changes of the ipsilateral and contralateral mammary glands were retrospectively evaluated by F-18 fluorodeoxyglucose (FDG) PET/CT after whole breast irradiation following lumpectomy in five breast cancer patients. The maximum standardized uptake values (SUVmax) of the ipsilateral mammary gland (S1) and the contralateral mammary gland (S0) were measured. The relative SUVmax (= S1/S0) was measured immediately before, one year after, three years after, and five years after radiation therapy.ResultsThe SUVmax of the ipsilateral mammary gland decreased gradually, but there was no decrease in the SUVmax of the contralateral mammary gland. Relative SUVmax values before, 1, 3, and 5 years after radiation therapy were 1.33 ± 0.20, 1.13 ± 0.35, 0.99 ± 0.26 and 0.62 ± 0.10, respectively. Relative SUVmax value at 5 years was significantly lower than before radiation therapy (P < 0.01).Conclusions18F-FDG PET/CT may be useful in assessing mammary gland function and predict lactation disorders in advance.

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Section: Discussionmentioning

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Quantitative evaluation of radiation-induced metabolic changes in the ipsilateral breast by FDG-PET/CT

Hama

2022

Imaging

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“…The study on efficacy encompassed three metrics, namely LR, OS, and DFS. Before this study, three meta-analyses reported on pooled LR and OS [ 57 – 59 ]. The results of our research align with their findings, indicating that there were no notable disparities between the two treatment protocols regarding LR and OS outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…The search we performed in this paper was thorough and the studies we considered featured high-quality RCTs and retrospective investigations, which enhanced the dependability of the results. Compared to prior meta-analyses on the same topic [ 57 – 59 ], our sample size and the research measures for side effects were larger, and we included ductal carcinoma in situ (DCIS) patients for the first time. Specifically, the sample size of Andrade et al [ 59 ]was restricted to six studies, while the study conducted by Zhou et al .…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety analysis of hypofractionated and conventional fractionated radiotherapy in postoperative breast cancer patients

Lu,

Hui,

Yang

et al. 2024

BMC Cancer

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Objectives In this meta-analysis, we conducted a comparative analysis of the safety and efficacy of hypofractionated and conventional fractionated radiotherapy in individuals who had undergone surgery for breast cancer. Methods This study involved a systematic and independent review of relevant research articles published in reputable databases such as PubMed, Embase, Cochrane Library, and Web of Science. Two investigators conducted the review, which included studies published up to January 3, 2023. The quality of the eligible studies was evaluated and data were extracted using Review Manager software 5.4 (RevMan 5.4) to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Results The analysis comprised 35 studies and encompassed a collective sample of 18,246 individuals diagnosed with breast cancer. We did not find a statistically significant disparity in efficacy between conventional fractionated (CF) radiotherapy and hypofractionated (HF) radiotherapy regarding local recurrence (LR; OR = 0.91, 95% CI: 0.76–1.09, P = 0.30), disease-free survival (DFS; OR = 1.20, 95% CI: 1.01–1.42, P = 0.03), and overall survival (OS; OR = 1.08, 95% CI: 0.93–1.26, P = 0.28). Concerning safety, there was no significant difference between the HF and CF regimens in terms of breast pain, breast atrophy, lymphedema, pneumonia, pulmonary fibrosis, telangiectasia, and cardiotoxicity. However, the HF regimen resulted in lower skin toxicity (OR = 0.43, 95% CI: 0.33—0.55, P < 0.01) and improved patient fatigue outcomes (OR = 0.73, 95% CI: 0.60 – 0.88, P < 0.01). Conclusions Although there is no substantial difference in LR, DFS, OS, or many other side effects between the HF and CF regimens, the HF regimen reduces skin toxicity and relieves patient fatigue. If these two issues need to be addressed in clinical situations, the HF regimen may be a superior alternative to conventional radiotherapy in postoperative breast cancer patients.

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“…Therefore, it is intensely discussed how the differently fractionated regimens of radiotherapy affect the outcome both in efficiency and toxicity. Some follow-up studies and meta-analyses have shown that the outcome of HypoRT could be compared to NormRT in efficiency, while other studies assume toxicity and side effects as fibrosis (14)(15)(16)(17)(18). HypoRT could potentially increase the patient's satisfaction and compliance by reducing the amount of treatments needed while reducing costs for the health care system for shorter therapeutic periods and therefore allowing the treatment of more patients (19,20).…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of hypofractionated and normofractionated radiotherapy in a triple‐negative breast cancer model

et al. 2022

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Breast cancer (BC) is one of the most diagnosed malignant carcinomas in women with a triple-negative breast cancer (TNBC) phenotype being correlated with poorer prognosis. Fractionated radiotherapy (RT) is a central component of breast cancer management, especially after breast conserving surgery and is increasingly important for TNBC subtype prognosis. In recent years, moderately hypofractionated radiation schedules are established as a standard of care, but many professionals remain skeptical and are concerned about their efficiency and side effects. In the present study, two different triple-negative breast cancer cell lines, a non-malignant breast epithelial cell line and fibroblasts, were irradiated daily under normofractionated and hypofractionated schedules to evaluate the impact of different irradiation regimens on radiation-induced cell-biological effects. During the series of radiotherapy, proliferation, growth rate, double-strand DNA break-repair (DDR), cellular senescence, and cell survival were measured. Investigated normal and cancer cells differed in their responses and receptivity to different irradiation regimens, indicating cell line/cell type specificity of the effect. At the end of both therapy concepts, normal and malignant cells reach almost the same endpoint of cell count and proliferation inhibition, confirming the clinical observations in the follow-up at the cellular level. These result in cell lines closely replicating the irradiation schedules in clinical practice and, to some extent, contributing to the understanding of growth rate or remission of tumors and the development of fibrosis.

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Comparing Hypofractionated With Conventional Fractionated Radiotherapy After Breast-Conserving Surgery for Early Breast Cancer: A Meta-Analysis of Randomized Controlled Trials

Cited by 16 publications

References 63 publications

Quantitative evaluation of radiation-induced metabolic changes in the ipsilateral breast by FDG-PET/CT

Quantitative evaluation of radiation-induced metabolic changes in the ipsilateral breast by FDG-PET/CT

Efficacy and safety analysis of hypofractionated and conventional fractionated radiotherapy in postoperative breast cancer patients

Effectiveness of hypofractionated and normofractionated radiotherapy in a triple‐negative breast cancer model

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