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. 2023 Jan 31:13:1081201.
doi: 10.3389/fonc.2023.1081201. eCollection 2023.

The optimal regional irradiation volume for breast cancer patients: A comprehensive systematic review and network meta-analysis of published studies

Wei-Xiang Qi  1 , Lu Cao  1 , Cheng Xu  1 , Gang Cai  1 , Jiayi Chen  1
Affiliations

The optimal regional irradiation volume for breast cancer patients: A comprehensive systematic review and network meta-analysis of published studies

Wei-Xiang Qi et al. Front Oncol. .

Abstract

Background: Currently, the optimal adjuvant regional nodal irradiation (RNI) volume for breast cancer (BC) remained controversial. We aimed to define the optimal RNI treatment volume for BC by using a comprehensive network meta-analysis (NMA) of published studies.

Materials and methods: PubMed, Embase, Medline, and Cochrane Central Register of Controlled Trials were searched from database inception to 30 May 2022. Studies assessing different adjuvant RNI volumes for BC were eligible for inclusion. The primary outcome was overall survival (OS), and secondary outcome was disease-free survival (DFS) and distant-metastasis-free survival (DMFS).

Results: A total of 29,640 BC patients from twenty studies were included. The pooled hazard ratio demonstrated that internal mammary node irradiation (IMNI) in BC patients significantly improved OS giving HR (hazard ratio) of 0.87 (95%CI: 0.83-0.91, p<0.001), DFS with HR of 0.78 (95%CI: 0.68-0.90, p<0.01), and DMFS with HR of 0.87 (95%CI: 0.79-0.97, p<0.01) when compared to controls. Sub-group analysis indicated that RNI with IMNI significantly improved OS (HR 0.87, 95%CI: 0.81-0.93, p<0.01), DFS (HR 0.65, 95%CI: 0.56-0.77, p<0.01), and DMFS (HR 0.90, 95%CI: 0.82-0.98, p=0.02) when compared to RNI without IMNI. NMA showed that CW/WB (chest wall/whole breast) + RNI with IMNI significantly improved DFS (HR 0.93, 95%CI: 0.86-1.00) and DMFS (HR 0.90, 95%CI: 0.81-0.99), but not for OS (HR 0.93, 95%CI: 0.84-1.03) when compared to CW/WB alone. Based on the analysis of the treatment ranking, CW/WB+RNI with IMNI appeared as the best treatment approach for BC patients.

Conclusions: Our pooled results demonstrated that RNI with IMNI yielded a significant survival advantage for BC patients. NMA showed that CW/WB+RNI with IMNI was the optimal radiation volume for BC patients.

Keywords: breast cancer; network meta-analysis; regional irradiation volume; survival; systematic review.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram.
Figure 2
Figure 2
Comparison survival outcomes of RNI with IMNI vs. RNI without IMNI in early-stage BC. (A) OS; (B) DFS; (C) DMFS.
Figure 3
Figure 3
Sub-group analysis of OS according to RNI volume in early-stage BC.
Figure 4
Figure 4
Network analysis of different RNI volume versus CW/WB alone early-stage BC. (A) OS; (B) DFS; (C) DMFS.
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