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Meta-Analysis
. 2023 Jul 3:2023:9035266.
doi: 10.1155/2023/9035266. eCollection 2023.

The Efficacy of Low-Kilovoltage X-Rays Intraoperative Radiation as Boost for Breast Cancer: A Systematic Review and Meta-Analysis

Yuanjian Fan  1 , Ruiwan Chen  2 , Ying Lu  3 , Ying Lin  1 , Yunjian Zhang  1 , Nan Shao  1 , Shenming Wang  1 , Dahong Nie  2 , Zhen Shan  1
Affiliations
Meta-Analysis

The Efficacy of Low-Kilovoltage X-Rays Intraoperative Radiation as Boost for Breast Cancer: A Systematic Review and Meta-Analysis

Yuanjian Fan et al. Breast J. .

Abstract

Background: Intraoperative radiotherapy (IORT) is a novel promising technology that may replace external beam radiation therapy (EBRT) as boost for patients receiving breast-conserving surgery. To better evaluate the efficacy of IORT using low-kilovoltage (low-kV) X-rays as boost, we presented this meta-analysis according to the PRISMA checklist.

Methods: Studies reported survival outcomes of intraoperative radiation using low-kilovoltage X-rays system (Intrabeam®, Carl Zeiss Meditec, Dublin, CA, USA) as boost were identified through electronic bibliographic database: PUBMED. The meta-analysis module in Stata (16.0) is used to pool the studies. A Poisson regression model is used to predict a 5-year local recurrence rate.

Results: Twelve studies including 3006 cases were included in the final analysis, with a median follow-up of 55 months weighted by sample size. The pooled local recurrence rate is 0.39% per person-year (95% CI: 0.15%-0.71%), with a low degree of heterogeneity (I2 = 0%). The predicted 5-year local recurrence rate was 3.45%. No difference in pooled local recurrence rate was found between non-neoadjuvant patients studies and neoadjuvant patients studies (0.41% per person-year vs. 0.58% per person-year, P = 0.580).

Conclusions: This study shows that low-kV IORT is an effective method as boost in breast cancer patients, with a low pooled local recurrence rate and low predicted 5-year local recurrence rate. Besides, no difference in the local recurrence rate was found between non-neoadjuvant patients studies and neoadjuvant patients studies. Low-kV IORT boost may be a promising alternative to EBRT boost in the future, which is being tested in the ongoing TARGIT-B trial.

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Conflict of interest statement

All authors have completed the ICMJE uniform disclosure form. The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Flow diagram of studies identifying inclusion and exclusion.
Figure 2
Figure 2
Forrest plot of the pooled local recurrence rate of 12 studies.
Figure 3
Figure 3
Predicted the 5-year local recurrence rate using the Poisson regression model. Each blue circle represents one study. (a) The estimated 5-year recurrence rate (orange triangle) with 11 non-NAT literature studies using the Poisson regression model is 2.66% (95% CI: 0% to 12.80%). (b) The estimated 5-year recurrence rate (orange triangle) with all 13 literature studies using the Poisson regression model is 3.45% (95% CI: 0% to 14.30%).
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