Toxicity and clinical outcomes of partial breast irradiation (PBI) compared to whole breast irradiation (WBI) for early stage breast cancer: A systematic review and meta-analysis
Bibliographic record
Abstract
Background: There is uncertainty about efficacy and toxicity differences between adjuvant PBI and WBI in women with early-stage breast cancer treated with breast conservation. Methods: We identified randomized trials that compared PBI to WBI in early-stage invasive breast cancer using PubMed. Odds ratios (ORs), 95% confidence intervals (CI) and absolute risks were computed for pre-specified efficacy and toxicity outcomes including cosmetics. Subgroup analysis evaluated the effect of PBI modality (external beam radiation treatment [EBRT], intraoperative radiation treatment [IORT] or brachytherapy) on efficacy. Meta-regression analysis explored the influence of median follow-up as well as patients and tumor characteristics on results. Results: Eight trials comprising 10298 patients were included. Efficacy results, weighted absolute differences and subgroup analysis are shown in the table. PBI was associated with increased odds of local recurrence compared to WBI. However, PBI was associated with reduced odds of death without breast cancer recurrence and improved overall survival (OS). Subgroup analysis showed the effect on local recurrence was influenced by modality of radiation; odds of local recurrence were increased with IORT and brachytherapy, but not with EBRT. Nodal involvement was associated with higher local recurrence risk while larger tumors were associated with lesser improvement in death without breast cancer recurrence and OS. PBI was associated with higher odds of fat necrosis (p = 0.002). Worse cosmetic outcome with PBI approached significance (p = 0.06). Conclusions: Compared to WBI, PBI is associated with higher odds for local recurrence and toxicity, but less death without breast cancer recurrence and improved OS. The balance between benefit and risk of PBI appears optimal for women with smaller ER positive tumors and without nodal involvement.Table: 246POR, 95% CIP value all/subgroup differenceWeighted absolute difference5-year local recurrenceAll2.28 (1.66-3.15)<0.0011.47%EBRT IORT Brachytherapy0.64 (0.25-1.62) 3.1 (2.12-4.51) 1.44 (0.63-3.29)0.0045-year regional recurrenceAll1.49 (0.88-2.53)0.140.3%EBRT IORT Brachytherapy1.96 (0.20-18.92) 1.45 (0.80-2.63) 1.56 (0.39-6.27)0.975-year contralateral breast cancerAll0.94 (0.59-1.47)0.77-0.1%EBRT IORT Brachytherapy0.85 (0.44-1.63) 1.54 (0.65-3.66) 0.64 (0.25-1.62)0.375-year death without breast cancer recurrenceAll0.55 (0.41-0.73)<0.001-1.6%EBRT IORT Brachytherapy0.71 (0.42-1.20) 0.45 (0.29-0.69) 0.57 (0.29-1.13)0.415-year overall survivalAll0.76 (0.61-0.95)0.02-1.1%EBRT IORT Brachytherapy0.79 (0.51-1.22) 0.78 (0.59-1.04) 0.61 (0.32-1.14)0.75 Open table in a new tab Legal entity responsible for the study: Hadar Goldvaser. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.022 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.015 | 0.031 |
| Bibliometrics | 0.004 | 0.004 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".