Efficacy and safety of intraoperative radiotherapy in breast conservative surgery for breast cancer patients: a meta-analysis

Abstract

Objective To evaluate the clinical efficacy and safety of intraoperative radiotherapy in breast conservative surgery for breast cancer patients. Methods The databases including CNKI, VIP, Wanfang, PubMed, Cochrane, Web of Science, Embase were retrieved to identify clinical trials which investigated the efficacy and safety of intraoperative radiotherapy in breast conservative surgery from the date of establishment to December 20, 2018. Two researchers independently performed literature screening, data extraction, and methodological quality evaluation according to the inclusion and exclusion criteria. An meta-analysis of the included studies was performed using RevMan 5.3 software. Results Totally 12 clinical trials (6 277 subjects) including 8 randomized controlled trials (RCT) and 4 non-RCT were enrolled. Meta-analysis showed that the local recurrence rate in patients with intraoperative radiotherapy was significantly higher than that in patients with postoperative radiotherapy (RR=2.78, 95%CI: 1.25-6.19, P=0.01), and the wound healing time was significantly longer [mean difference (MD)=5.92, 95%CI: 5.46-6.37, P<0.01]. There was no significant difference in distant metastasis rate and overall survival between intraoperative radiotherapy group and postoperative radiotherapy group (RR=0.92, 95%CI: 0.62-1.37, P=0.68; RR=1.01, 95%CI: 1.00-1.01, P=0.26). The patients undergoing intraoperative radiotherapy had significantly better cosmetic effect compared with the patients with postoperative radiotherapy (RR=1.17, 95%CI: 1.05-1.31, P<0.01). The fat liquefaction rate and exudation rate presented no significant difference between intraoperative radiotherapy group and postoperative radiotherapy group(RR=2.18, 95%CI: 0.71-6.72, P=0.18; RR=1.55, 95%CI: 0.36-6.68, P=0.56). Conclusion Intraoperative radiotherapy is not inferior to postoperative radiotherapy in distant metastasis rate, overall survival and adverse reaction, but with better cosmetic effect and a higher local recurrence rate, so the patients with low risk of recurrence are recommended. Key words: Breast neoplasms; Meta-analysis; Radiotherapy; Breast conservative surgery