目的:在本荟萃分析中,我们对接受过乳腺癌手术的患者进行了大分割和常规分割放疗的安全性和有效性进行了比较分析.
方法:本研究涉及对发表在诸如PubMed、Embase,科克伦图书馆,和WebofScience。两名调查人员进行了审查,其中包括截至2023年1月3日发表的研究。评估合格研究的质量,并使用ReviewManager软件5.4(RevMan5.4)提取数据,以计算比值比(ORs)和95%置信区间(CIs)。
结果:分析包括35项研究,包括18,246名被诊断患有乳腺癌的个体的集体样本。我们没有发现常规分割(CF)放疗和大分割(HF)放疗在局部复发方面的疗效差异有统计学意义(LR;OR=0.91,95%CI:0.76-1.09,P=0.30),无病生存率(DFS;OR=1.20,95%CI:1.01-1.42,P=0.03),总生存期(OS;OR=1.08,95%CI:0.93-1.26,P=0.28)。关于安全,HF和CF方案在乳房疼痛方面没有显着差异,乳房萎缩,淋巴水肿,肺炎,肺纤维化,毛细血管扩张症,和心脏毒性。然而,HF方案可降低皮肤毒性(OR=0.43,95%CI:0.33-0.55,P<0.01),改善患者疲劳结局(OR=0.73,95%CI:0.60-0.88,P<0.01).
结论:尽管LR没有实质性差异,DFS,操作系统,或HF和CF方案之间的许多其他副作用,HF方案可降低皮肤毒性并缓解患者疲劳。如果在临床上需要解决这两个问题,在乳腺癌术后患者中,HF方案可能是常规放疗的优越替代方案.
OBJECTIVE: In this meta-analysis, we conducted a comparative analysis of the safety and efficacy of hypofractionated and conventional fractionated radiotherapy in individuals who had undergone surgery for breast cancer.
METHODS: This study involved a systematic and independent review of relevant research articles published in reputable databases such as PubMed, Embase, Cochrane Library, and Web of Science. Two investigators conducted the review, which included studies published up to January 3, 2023. The quality of the eligible studies was evaluated and data were extracted using Review Manager software 5.4 (RevMan 5.4) to calculate odds ratios (ORs) and 95% confidence intervals (CIs).
RESULTS: The analysis comprised 35 studies and encompassed a collective sample of 18,246 individuals diagnosed with breast cancer. We did not find a statistically significant disparity in efficacy between conventional fractionated (CF) radiotherapy and hypofractionated (HF) radiotherapy regarding local recurrence (LR; OR = 0.91, 95% CI: 0.76-1.09, P = 0.30), disease-free survival (DFS; OR = 1.20, 95% CI: 1.01-1.42, P = 0.03), and overall survival (OS; OR = 1.08, 95% CI: 0.93-1.26, P = 0.28). Concerning safety, there was no significant difference between the HF and CF regimens in terms of breast pain, breast atrophy, lymphedema, pneumonia, pulmonary fibrosis, telangiectasia, and cardiotoxicity. However, the HF regimen resulted in lower skin toxicity (OR = 0.43, 95% CI: 0.33-0.55, P < 0.01) and improved patient fatigue outcomes (OR = 0.73, 95% CI: 0.60 - 0.88, P < 0.01).
CONCLUSIONS: Although there is no substantial difference in LR, DFS, OS, or many other side effects between the HF and CF regimens, the HF regimen reduces skin toxicity and relieves patient fatigue. If these two issues need to be addressed in clinical situations, the HF regimen may be a superior alternative to conventional radiotherapy in postoperative breast cancer patients.