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Side Effects Associated with the Use of Intensity-Modulated Radiation Therapy in Breast Cancer Patients Undergoing Adjuvant Radiation Therapy: A Systematic Review and Meta-Analysis

Published:October 17, 2017DOI:https://doi.org/10.1016/j.jmir.2017.09.002

      Abstract

      Purpose

      The purpose of the study was to establish the efficacy and safety of breast intensity-modulated radiation therapy (IMRT) compared with non-IMRT standard wedge radiation therapy (RT) for the treatment of adjuvant breast cancer.

      Methods

      A systematic review and meta-analysis were completed using STATA and a random effects model. A total of 1,499 citations were identified from the literature search. Of those, 1,475 were excluded based on abstract review. Full texts of 24 remaining articles were reviewed and 11 articles were included in the final analysis. Side effects were analysed as the primary outcomes of interest. We calculated individual odds ratios and 95% confidence intervals for 17 classifications of side effects reported. The data for eight classifications of side effects were then pooled for meta-analyses to obtain more precise estimates of the relationships between adjuvant RT and a particular side effect.

      Results

      The pooled analyses revealed potential protective associations between adjuvant IMRT and two acute side effects: dermatitis and moist desquamation. The remaining pooled estimates suggest that the odds of developing edema, hyperpigmentation, fat necrosis, pain, induration were no worse, nor better among those treated with IMRT compared with those treated with non-IMRT standard wedge RT.

      Conclusion

      The pooled estimates from this meta-analysis are in line with the existing evidence. When the outcome of interest is reduction of the acute side effects: dermatitis and moist desquamation IMRT is a viable treatment option for women undergoing external beam RT after breast-conserving surgery.

      Résumé

      But

      Les auteurs souhaitent établit l'efficacité et la sécurité de la radiothérapie conformationnelle avec modulation d'intensité (RCMI) en comparaison de la radiothérapie (RT) non RCMI standard avec filtre en coin pour le traitement du cancer du sein avec adjuvant.

      Méthodologie

      Un examen systématique et une méta-analyse ont été effectuées à l'aide de STATA et d'un modèle d'effets aléatoires. Au total, 1 499 citations ont été recensées dans la recherche documentaire. De celles-ci, 1 475 ont été exclues à partir de l'examen du résumé. Le texte complet des 24 articles restants a été examiné et 11 articles ont été retenus pour l'analyse finale. Les effets secondaires ont été analysés comme résultat d'intérêt primaire. Nous avons calculé le rapport de cotes (odds ratio-OR) et l'intervalle de confiance à 95% (IC 95%) pour 17 classifications d'effets secondaires signalés. Les données pour huit des classifications d'effets secondaire ont ensuite été regroupées pour la méta-analyse afin d'obtenir une estimation plus précise du lien entre la radiothérapie adjuvante et un effet secondaire en particulier.

      Résultats

      Les analyses regroupées révèlent des associations protectives potentielles entre la RCMI adjuvante et deux effets secondaires aigus, la dermatite et la desquamation humide. Les estimations regroupées restantes suggèrent que les chances de développer de l’œdème, l'hyperpigmentation, la stéatonécrose, la douleur ou l'induration n’étaient pas plus élevées chez les patients traités par RCMI en comparaison de celles traitées par RT non RCMI standard avec filtre en coin.

      Conclusion

      Les estimations regroupées de notre méta analyse correspondent aux données probantes existantes. Lorsque le résultat d'intérêt est à réduction des effets secondaires aigus: dermatite et desquamation humide, la RCMI est une option de traitement viable pour les femmes qui reçoivent une radiothérapie à faisceau externe après une chirurgie conservatrice du sein.

      Keywords

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