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Poster display session: Breast cancer - early stage, locally advanced & metastatic, CNS tumours, Developmental therapeutics, Genitourinary tumours - prostate & non-prostate, Palliative care, Psycho-oncology, Public health policy, Sarcoma, Supportive care

4740 - Toxicity and Clinical Outcomes of Partial Breast Irradiation (PBI) Compared to Whole Breast Irradiation (WBI) for Early Stage Breast Cancer: A Systematic Review and Meta-analysis

Date

22 Oct 2018

Session

Poster display session: Breast cancer - early stage, locally advanced & metastatic, CNS tumours, Developmental therapeutics, Genitourinary tumours - prostate & non-prostate, Palliative care, Psycho-oncology, Public health policy, Sarcoma, Supportive care

Presenters

Hadar Goldvaser

Citation

Annals of Oncology (2018) 29 (suppl_8): viii58-viii86. 10.1093/annonc/mdy270

Authors

H. Goldvaser1, A. Fyles2, D. Shepshelovich1, E. Amir3, Y. Korzets2

Author affiliations

  • 1 Medical Oncology, Princess Margaret Cancer Centre, M5G 2M9 - Toronto/CA
  • 2 Radiation oncology, Princess Margaret Cancer Centre, M5G 2M9 - Toronto/CA
  • 3 Department Of Medical Oncology, Princess Margaret Cancer Centre, M5G2M9 - Toronto/CA
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Resources

Abstract 4740

Background

There is uncertainty about efficacy and toxicity differences between adjuvant PBI and WBI in women with early-stage breast cancer treated with breast conservation.

Methods

We identified randomized trials that compared PBI to WBI in early-stage invasive breast cancer using PubMed. Odds ratios (ORs), 95% confidence intervals (CI) and absolute risks were computed for pre-specified efficacy and toxicity outcomes including cosmetics. Subgroup analysis evaluated the effect of PBI modality (external beam radiation treatment [EBRT], intraoperative radiation treatment [IORT] or brachytherapy) on efficacy. Meta-regression analysis explored the influence of median follow-up as well as patients and tumor characteristics on results.

Results

Eight trials comprising 10298 patients were included. Efficacy results, weighted absolute differences and subgroup analysis are shown in the table. PBI was associated with increased odds of local recurrence compared to WBI. However, PBI was associated with reduced odds of death without breast cancer recurrence and improved overall survival (OS). Subgroup analysis showed the effect on local recurrence was influenced by modality of radiation; odds of local recurrence were increased with IORT and brachytherapy, but not with EBRT. Nodal involvement was associated with higher local recurrence risk while larger tumors were associated with lesser improvement in death without breast cancer recurrence and OS. PBI was associated with higher odds of fat necrosis (p = 0.002). Worse cosmetic outcome with PBI approached significance (p = 0.06).Table: 246P

OR, 95% CIP value all/ subgroup differenceWeighted absolute difference
5-year local recurrence
All2.28 (1.66-3.15)<0.0011.47%
EBRT IORT Brachytherapy0.64 (0.25-1.62) 3.1 (2.12-4.51) 1.44 (0.63-3.29)0.004
5-year regional recurrence
All1.49 (0.88-2.53)0.140.3%
EBRT IORT Brachytherapy1.96 (0.20-18.92) 1.45 (0.80-2.63) 1.56 (0.39-6.27)0.97
5-year contralateral breast cancer
All0.94 (0.59-1.47)0.77-0.1%
EBRT IORT Brachytherapy0.85 (0.44-1.63) 1.54 (0.65-3.66) 0.64 (0.25-1.62)0.37
5-year death without breast cancer recurrence
All0.55 (0.41-0.73)<0.001-1.6%
EBRT IORT Brachytherapy0.71 (0.42-1.20) 0.45 (0.29-0.69) 0.57 (0.29-1.13)0.41
5-year overall survival
All0.76 (0.61-0.95)0.02-1.1%
EBRT IORT Brachytherapy0.79 (0.51-1.22) 0.78 (0.59-1.04) 0.61 (0.32-1.14)0.75

Conclusions

Compared to WBI, PBI is associated with higher odds for local recurrence and toxicity, but less death without breast cancer recurrence and improved OS. The balance between benefit and risk of PBI appears optimal for women with smaller ER positive tumors and without nodal involvement.

Clinical trial identification

Legal entity responsible for the study

Hadar Goldvaser.

Funding

Has not received any funding.

Editorial Acknowledgement

Disclosure

All authors have declared no conflicts of interest.

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