Systematic Review Of The Radiotherapy Of Early Breast Cancer After Breast Conserving-surgery

Objective:The aim of the study was to conduct a systematic reviewwith meta-analysis to compare the PBI with WBI, and to evaluate the effect of PBI for the early breast cancer after breast conserving surgery.Meterials and Methods:A fully recursive literature search was conducted in the databases such as Pubmed、Medline、Cochrane and CNKI、CBM for studies of the PBI and WBI that were published in any language, from January1990to March2014. Studies were included if they reported risk of Local Recurrence and Overall Survival or Cancer-specific Survival. We undertook a systematic review of individual patient data for5859women in5randomised trials of Partial Beast Irradiation versus Whole Breast Irradiation after breast-conserving surgery. Analyses were carried out using RevMan5.2software.The Relative Risk is used to evaluate the data. The quality of trials were critically assessed by the criteria from the Cochrane Reviewer Handbook version5.1.0and all these RCTs were graded B.The I2test was used to compare heterogeneity.Sensitivity analysis was used to evaluate the stability and reliability of the results. Results:1.A search of five trials totally with5859patients,including2939patients of partial breast irradiation,2956patients of whole-breast irradiation. After assessed by the Cochrane Reviewer Handbook version5.1.0quality criteria, all these five RCTs received grade B.2.statistical analysis:1)There were not significant differences associated with Overall Survival (OS) between PBI and WBI (RR=1.00,95%CI [0.99to1.02]);2) There were not significant differences associated with Cancer Specific Survival (CSS) between PBI and WBI (RR=1.00,95%CI [0.99to1.01]);3) There were significant differences associated with Local Recurrence (LR) between PBI and WBI (RR=2.80;95%CI[1.94to4.03]);4) There were significant differences associated with Regional Recurrence (RR) between PBI and WBI (RR=2.73,95%CI[1.76to4.25]);5) There were not significant differences associated with Distant Metastasis (DM) between PBI and WBI (RR=0.79,95%CI [0.60to1-04]);6) There were significant differences associated with Non-Breast Cancer Death (NBCD) between PBI and WBI (RR=0.63,95%CI [0.41to 0.98]).Conclusions:The PBI in the breast-conserving therapy is not inferior to WBI. Compared to WBI, the PBI increased RR and LR, but it seems that OS、 CSS and DM have no difference between the PBI and WBI. Furthermore, PBI decreased NBCD. PBI is available for the patients with low risk of recurrence. But it still needs further large randomized control trials to indicate the role of PBI in the treatment for breast conserving surgery.