Intraoperative radiotherapy: An alternative to whole-breast external beam radiotherapy in the management of highly selective breast cancer: A SEER database analysis

IF 2.9 2区医学 Q2 ONCOLOGY Cancer Medicine Pub Date : 2024-08-19 DOI:10.1002/cam4.7458

Dexun Sun, Guanhua Lu, Fenmei Liang, Wangjian Zhang, Tao Zeng, Yun Ling, Haojie Peng, Ting Xia, Meilin Hu, Xinxin Chen

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Abstract

Objective

This study aimed to verify if intraoperative radiotherapy (IORT) can achieve the same survival outcome as whole-breast external beam radiotherapy (EBRT) in early breast cancer after breast-conserving surgery (BCS), and to explore the suitable candidates that can safely receive IORT after BCS.

Methods

Eligible post-BCS patients who received IORT or EBRT were included in the Surveillance, Epidemiology and End Results (SEER) database from 2010 to 2018. Risk factors that affected 5-year overall survival (OS) or breast cancer specific survival (BCSS) were identified by Cox proportional hazards regression analysis. Clinical characteristics, OS, and BCSS were comparatively analyzed between the two treatment modalities.

Results

The survival analysis after propensity score matching confirmed that patients who received IORT (n = 2200) had a better 5-year OS than those who received EBRT (n = 2200) (p = 0.015). However, the two groups did not differ significantly in 5-year BCSS (p = 0.381). This feature persisted even after multivariate analyses that took into account numerous clinical characteristics. Although there was no significant difference in BCSS between different subgroups of patients treated with IORT or EBRT, patients over 55 years of age, with T1, N0, non-triple negative breast cancers, hormone receptor-positive, and histologic grade II showed a better OS after receiving IORT.

Conclusion

In low-risk, early-stage breast cancer, IORT was not inferior to EBRT considering 5-year BCSS and OS. Considering the equivalent clinical outcome but less radiotoxicity, IORT might be a reasonable alternative to EBRT in highly selective patients undergoing BCS.

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术中放疗：高选择性乳腺癌治疗中全乳房体外放射治疗的替代方案：SEER 数据库分析。

研究目的本研究旨在验证术中放疗（IORT）在保乳手术（BCS）后的早期乳腺癌患者中是否能获得与全乳房外照射放疗（EBRT）相同的生存效果，并探索BCS术后可安全接受IORT的合适人选：2010年至2018年期间，监测、流行病学和最终结果（SEER）数据库收录了接受IORT或EBRT治疗的符合条件的BCS术后患者。通过Cox比例危害回归分析确定了影响5年总生存率（OS）或乳腺癌特异生存率（BCSS）的风险因素。对两种治疗方式的临床特征、OS和BCSS进行了比较分析：倾向得分匹配后的生存率分析证实，接受IORT治疗的患者（n = 2200）的5年生存率优于接受EBRT治疗的患者（n = 2200）（p = 0.015）。然而，两组患者的 5 年 BCSS 没有显著差异（p = 0.381）。即使在考虑了多种临床特征的多变量分析后，这一特征依然存在。虽然接受IORT或EBRT治疗的不同亚组患者的BCSS没有明显差异，但55岁以上、T1、N0、非三阴性乳腺癌、激素受体阳性、组织学分级为II级的患者在接受IORT治疗后的OS更好：结论：对于低风险早期乳腺癌患者，考虑到5年BCSS和OS，IORT并不比EBRT差。考虑到同等的临床效果和较低的放射性毒性，对于接受 BCS 的高选择性患者来说，IORT 可能是 EBRT 的合理替代方案。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cancer Medicine ONCOLOGY-

CiteScore

5.50

自引率

2.50%

发文量

907

审稿时长

19 weeks

期刊介绍： Cancer Medicine is a peer-reviewed, open access, interdisciplinary journal providing rapid publication of research from global biomedical researchers across the cancer sciences. The journal will consider submissions from all oncologic specialties, including, but not limited to, the following areas: Clinical Cancer Research Translational research ∙ clinical trials ∙ chemotherapy ∙ radiation therapy ∙ surgical therapy ∙ clinical observations ∙ clinical guidelines ∙ genetic consultation ∙ ethical considerations Cancer Biology: Molecular biology ∙ cellular biology ∙ molecular genetics ∙ genomics ∙ immunology ∙ epigenetics ∙ metabolic studies ∙ proteomics ∙ cytopathology ∙ carcinogenesis ∙ drug discovery and delivery. Cancer Prevention: Behavioral science ∙ psychosocial studies ∙ screening ∙ nutrition ∙ epidemiology and prevention ∙ community outreach. Bioinformatics: Gene expressions profiles ∙ gene regulation networks ∙ genome bioinformatics ∙ pathwayanalysis ∙ prognostic biomarkers. Cancer Medicine publishes original research articles, systematic reviews, meta-analyses, and research methods papers, along with invited editorials and commentaries. Original research papers must report well-conducted research with conclusions supported by the data presented in the paper.