Efficacy analysis of accelerated partial breast irradiation versus whole breast irradiation with simultaneous integrated boost after breast-conserving surgery for early-stage breast cancer

Abstract

Objective To evaluate the efficacy of accelerated partial breast irradiation (APBI) and whole breast irradiation (WBI) with simultaneous integrated boost (SIB) from the perspective of economics, and provide a reference for postoperative adjuvant therapy mode selection for early-stage breast cancer after breast-conserving surgery. Methods A total of 355 early-stage breast cancer patients who underwent APBI or WBI-SIB after breast-conserving surgery were evaluated on efficacy and cost-effectiveness, of which 177 patients received APBI, and 178 patients received WBI-SIB. Survival analysis was done according to treatment received. NCI-CTC 3.0 was used to score the toxicities. Breast aesthetic outcome were evaluated with Harris standards. Results Median follow-up was 42 months (5.8-92.7 months). The 3-year locoregional recurrence free survival(LRFS) rates in APBI group and WBI-SIB group were 98.2% and 97.6%, distant metastasis free survival(DMFS) were 94.3% and 93.7%, disease-free survival (DFS) were 93.1% and 91.6%, and overall survival 95.5% and 94.3%, respectively, without statistically significant differences(P>0.05). Compared with WBI-SIB group, the acute reaction rates in APBI group decreased from 5.6% to 3.4%(χ2=6.044, P<0.05), and late reactions from 5.6% to 2.3% (χ2=6.149, P<0.05), while the cosmetic outcome improved from 88.8% to 93.8%(χ2=5.22, P<0.05). Moreover, the processing average time was shortened by 26.5 d (χ2=40.76, P<0.05). Conclusions After breast-conserving surgery, the efficacy of APBI showed no difference from WBI-SIB with respect to 3-year local control, disease-free survival, and overall survival, but displayed a significantly better toxicity profile and cost-effectiveness ratio for early breast cancer patients. It can be used as a good radiotherapy model after breast-conserving surgery in early-stage breast cancer. Key words: Breast-conserving surgery; Accelerated partial breast irradiation (APBI); Whole breast irradiation (WBI); Simultaneous integrated boost (SIB); Efficacy