Breast-conserving surgery with or without radiotherapy in women with ductal carcinoma in situ: a meta-analysis of randomized trialsReportar como inadecuado

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Radiation Oncology

, 2:28

First Online: 02 August 2007Received: 10 June 2007Accepted: 02 August 2007


BackgroundTo investigate whether Radiation therapy RT should follow breast conserving surgery in women with ductal carcinoma in situ from breast cancer DCIS with objective of decreased mortality, invasive or non invasive recurrence, distant metastases and contralateral breast cancer rates. We have done a meta-analysis of these results to give a more balanced view of the total evidence and to increase statistical precision.

MethodsA meta-analysis of randomized controlled trials RCT was performed comparing RT treatment for DCIS of breast cancer to observation. The MEDLINE, EMBASE, CANCERLIT, Cochrane Library databases, Trial registers, bibliographic databases, and recent issues of relevant journals were searched. Relevant reports were reviewed by two reviewers independently and the references from these reports were searched for additional trials, using guidelines set by QUOROM statement criteria.

ResultsThe reviewers identified four large RCTs, yielding 3665 patients. Pooled results from this four randomized trials of adjuvant radiotherapy showed a significant reduction of invasive and DCIS ipsilateral breast cancer with odds ratio OR of 0.40 95% CI 0.33 – 0.60, p < 0.00001 and 0.40 95% CI 0.31 – 0.53, p < 0.00001, respectively. There was not difference in distant metastases OR = 1.04, 95% CI 0.57–1.91, p = 0.38 and death rates OR = 1.08, 95%CI 0.65 – 1.78, p = 0.45 between the two arms. There was more contralateral breast cancer after adjuvant RT 66-1711 = 3.85% versus observation 49-1954 = 2.5%. The likelihood of contralateral breast cancer was 1.53-fold higher 95% CI 1.05 – 2.24, p = 0.03 in radiotherapy arms.

ConclusionThe conclusion from our meta-analysis is that the addition of radiation therapy to lumpectomy results in an approximately 60% reduction in breast cancer recurrence, no benefit for survival or distant metastases compared to excision alone. Patients with high-grade DCIS lesions and positive margins benefited most from the addition of radiation therapy. It is not yet clear which patients can be successfully treated with lumpectomy alone; until further prospective studies answer this question, radiation should be recommended after lumpectomy for all patients without contraindications.

Electronic supplementary materialThe online version of this article doi:10.1186-1748-717X-2-28 contains supplementary material, which is available to authorized users.

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Autor: Gustavo A Viani - Eduardo J Stefano - Sérgio L Afonso - Lígia I De Fendi - Francisco V Soares - Paola G Leon - Flavi


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