Mapping the current landscape of locoregional therapy de-escalation trials in early breast cancer: a systematic review.

IF 7.6 2区医学 Q1 ONCOLOGY

NPJ Breast Cancer Pub Date : 2025-03-30 DOI:10.1038/s41523-025-00744-9

Alan D McCrorie, Hilary Stobart, David Dodwell, Stuart A McIntosh, Shelley Potter

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Abstract

A systematic review undertaken to map the current landscape of locoregional de-escalation trials to inform future research. Online databases and trial registries were searched to identify ongoing, recently completed or published studies de-escalating surgery or radiotherapy in patients with early breast cancer. 97 trials evaluated de-escalation of surgery or radiotherapy in up to 94,866 participants. Surgery studies more commonly evaluated treatment omission/reduction after neoadjuvant systemic therapy (NST) and de-escalation of nodal treatment. Radiotherapy studies were more frequently biomarker stratified. Patients were rarely involved in study design. Research questions focused on response-adjusted treatment after NST and omission/reduction of locoregional therapy in patients with low- or intermediate-risk disease. Significant duplication was identified with multiple studies addressing similar questions. This systematic review demonstrates that the current de-escalation portfolio is inefficient, lacks patient focus and needs improvement. An internationally collaborative approach using innovative study designs and patient partnership will be essential to address this.

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绘制早期乳腺癌局部区域治疗降级试验的现状：一项系统综述。

进行系统审查，以绘制当前地方区域降级试验的景观，为未来的研究提供信息。我们检索了在线数据库和试验注册库，以确定正在进行的、最近完成的或已发表的降低早期乳腺癌患者手术或放疗强度的研究。97项试验评估了94,866名参与者的手术或放疗的降级。外科研究更常评估新辅助全身治疗（NST）和淋巴结治疗降级后的治疗遗漏/减少。放疗研究更常采用生物标志物分层。患者很少参与研究设计。研究问题集中在低或中危疾病患者NST后的反应调整治疗和局部治疗的遗漏/减少。针对类似问题的多个研究发现了显著的重复。这一系统评价表明，目前的降级组合效率低下，缺乏对患者的关注，需要改进。采用创新研究设计和患者伙伴关系的国际合作方法对于解决这一问题至关重要。

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来源期刊

NPJ Breast Cancer Medicine-Pharmacology (medical)

CiteScore

10.10

自引率

1.70%

发文量

122

审稿时长

9 weeks

期刊介绍： npj Breast Cancer publishes original research articles, reviews, brief correspondence, meeting reports, editorial summaries and hypothesis generating observations which could be unexplained or preliminary findings from experiments, novel ideas, or the framing of new questions that need to be solved. Featured topics of the journal include imaging, immunotherapy, molecular classification of disease, mechanism-based therapies largely targeting signal transduction pathways, carcinogenesis including hereditary susceptibility and molecular epidemiology, survivorship issues including long-term toxicities of treatment and secondary neoplasm occurrence, the biophysics of cancer, mechanisms of metastasis and their perturbation, and studies of the tumor microenvironment.