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Systematic Review

Efficacy and Safety of the Addition of Internal Mammary Irradiation to Standard Adjuvant Radiation in Early-Stage Breast Cancer: A Systematic Review and Meta-Analysis

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Institute of Oncology, Tel Aviv Sourasky Medical Center, Weizmann St. 6, Tel-Aviv 6423906, Israel
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Sackler Faculty of Medicine, Tel Aviv University, Chaim Levanon St. 30, Tel-Aviv 6997801, Israel
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Oncology Institute, Shaare Zedek Medical Center, Shmuel Bait St. 12, Jerusalem 9103102, Israel
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Faculty of Medicine, Hebrew University, Ein Kerem. P.O. Box 12271, Jerusalem 9112102, Israel
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Department of Imaging, Rabin Medical Center, Jabotinsky St. 39, Petah Tikva 4941492, Israel
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Princess Margaret Cancer Centre, University of Toronto, 610 University Ave, Toronto, ON M5G 2C1, Canada
*
Author to whom correspondence should be addressed.
Curr. Oncol. 2022, 29(9), 6657-6673; https://doi.org/10.3390/curroncol29090523
Received: 5 August 2022 / Revised: 11 September 2022 / Accepted: 13 September 2022 / Published: 17 September 2022
Background: Existing data on adding internal mammary nodal irradiation (IMNI) to the regional nodal fields are inconsistent. Methods: Randomized trials investigating the addition of IMNI to standard adjuvant radiation were identified. Hazard ratios (HRs) and 95% confidence intervals (CI) were extracted for overall-survival (OS), breast cancer specific-survival (BCSS), and disease-free survival (DFS) as well as distant-metastasis free survival (DMFS). The odds ratios (ORs) for regional and loco-regional recurrence, non-breast cancer mortality, secondary non-breast cancer, contralateral breast cancer, and cardiovascular morbidity and mortality were also extracted. Results: Analysis included five trials comprising 10,994 patients, predominantly with higher risk, lymph node positive disease. Compared to the control group, IMNI was associated with significant improvement in OS (HR = 0.91, p = 0.004), BCSS (HR = 0.84, p < 0.001), DFS (HR = 0.89, p= 0.01), and DMFS (HR = 0.89, p = 0.02). IMNI was also associated with reduced odds for regional (OR = 0.58, p < 0.001) and loco-regional recurrence (OR = 0.85, p = 0.04). The odds for cardiotoxicity were not statistically significantly higher (OR = 1.23, p = 0.07). There were comparable odds for cardiovascular mortality (OR = 1.00, p = 1.00), non-breast cancer mortality (OR = 1.05, p = 0.74), secondary cancer (OR = 0.95, p = 0.51), and contra-lateral breast cancer (OR = 1.07, 95% 0.77–1.51, p = 0.68). Conclusions: Compared to the control group, the addition of IMNI in high-risk patients is associated with a statistically significant improvement in survival, albeit with a magnitude of questionable clinical meaningfulness. View Full-Text
Keywords: breast cancer; radiotherapy; internal mammary irradiation; regional nodal irradiation breast cancer; radiotherapy; internal mammary irradiation; regional nodal irradiation
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MDPI and ACS Style

Korzets, Y.; Levitas, D.; Grubstein, A.; Corn, B.W.; Amir, E.; Goldvaser, H. Efficacy and Safety of the Addition of Internal Mammary Irradiation to Standard Adjuvant Radiation in Early-Stage Breast Cancer: A Systematic Review and Meta-Analysis. Curr. Oncol. 2022, 29, 6657-6673. https://doi.org/10.3390/curroncol29090523

AMA Style

Korzets Y, Levitas D, Grubstein A, Corn BW, Amir E, Goldvaser H. Efficacy and Safety of the Addition of Internal Mammary Irradiation to Standard Adjuvant Radiation in Early-Stage Breast Cancer: A Systematic Review and Meta-Analysis. Current Oncology. 2022; 29(9):6657-6673. https://doi.org/10.3390/curroncol29090523

Chicago/Turabian Style

Korzets, Yasmin, Dina Levitas, Ahuva Grubstein, Benjamin W. Corn, Eitan Amir, and Hadar Goldvaser. 2022. "Efficacy and Safety of the Addition of Internal Mammary Irradiation to Standard Adjuvant Radiation in Early-Stage Breast Cancer: A Systematic Review and Meta-Analysis" Current Oncology 29, no. 9: 6657-6673. https://doi.org/10.3390/curroncol29090523

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