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Meta-Analysis
. 2023 Sep 7;115(9):1011-1019.
doi: 10.1093/jnci/djad100.

Partial breast irradiation compared with whole breast irradiation: a systematic review and meta-analysis

Dean A Shumway  1   2 , Kimberly S Corbin  1   2 , Magdoleen H Farah  1   3 , Kelly E Viola  1   3 , Tarek Nayfeh  1   3 , Samer Saadi  1   3 , Vishal Shah  1   3 , Bashar Hasan  1   3 , Sahrish Shah  1   3 , Khaled Mohammed  1 , Irbaz Bin Riaz  1 , Larry J Prokop  4 , M Hassan Murad  1   3 , Zhen Wang  1   3   5
Affiliations
Meta-Analysis

Partial breast irradiation compared with whole breast irradiation: a systematic review and meta-analysis

Dean A Shumway et al. J Natl Cancer Inst. .

Abstract

Background: Early-stage breast cancer is among the most common cancer diagnoses. Adjuvant radiotherapy is an essential component of breast-conserving therapy, and several options exist for tailoring its extent and duration. This study assesses the comparative effectiveness of partial-breast irradiation (PBI) compared with whole-breast irradiation (WBI).

Methods: A systematic review was completed to identify relevant randomized clinical trials and comparative observational studies. Independent reviewers working in pairs selected studies and extracted data. Randomized trial results were pooled using a random effects model. Prespecified main outcomes were ipsilateral breast recurrence (IBR), cosmesis, and adverse events (AEs).

Results: Fourteen randomized clinical trials and 6 comparative observational studies with 17 234 patients evaluated the comparative effectiveness of PBI. PBI was not statistically significantly different from WBI for IBR at 5 years (RR = 1.34, 95% CI = 0.83 to 2.18; high strength of evidence [SOE]) and 10 years (RR = 1.29, 95% CI = 0.87 to 1.91; high SOE). Evidence for cosmetic outcomes was insufficient. Statistically significantly fewer acute AEs were reported with PBI compared with WBI, with no statistically significant difference in late AEs. Data from subgroups according to patient, tumor, and treatment characteristics were insufficient. Intraoperative radiotherapy was associated with higher IBR at 5, 10, and over than 10 years (high SOE) compared with WBI.

Conclusions: Ipsilateral breast recurrence was not statistically significantly different between PBI and WBI. Acute AEs were less frequent with PBI. This evidence supports the effectiveness of PBI among selected patients with early-stage, favorable-risk breast cancer who are similar to those represented in the included studies.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Selection of trials for inclusion in the review and meta-analysis. IORT = intraoperative radiotherapy; PBI = partial-breast irradiation; WBI = whole-breast irradiation.
Figure 2.
Figure 2.
Findings of meta-analysis of PBI vs WBI for ipsilateral breast recurrence (IBR) and cosmetic outcome. PBI = partial-breast irradiation; RR = relative risk; SOE = strength of evidence; WBI = whole-breast irradiation; 95% CI = 95% confidence interval.
Figure 3.
Figure 3.
Findings of meta-analysis of adverse events (AEs) for partial-breast irradiation (PBI) and intraoperative radiotherapy (IORT) compared with whole-breast irradiation (WBI). IRR = incidence rate ratio; 95% CI = 95% confidence interval.
Figure 4.
Figure 4.
Findings of meta-analysis of IORT vs WBI for ipsilateral breast recurrence (IBR). IORT = intraoperative radiotherapy; RR = relative risk; SOE = strength of evidence; WBI = whole breast irradiation; pts = patients; 95% CI = 95% confidence interval.
See this image and copyright information in PMC

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