乳腺癌幸存者的慢性皮肤毒性:放疗技术的系统回顾和荟萃分析。

IF 3 3区 医学 Q2 ONCOLOGY
Breast Cancer Research and Treatment Pub Date : 2025-07-01 Epub Date: 2025-05-05 DOI:10.1007/s10549-025-07700-y
Shing Fung Lee, Henry C Y Wong, Jolien Robijns, Stephen Lowell B Ciocon, Paula Elaine Diniz Dos Reis, Sarina Sadeghi, Muna Al-Khaifi, Mami Ogita, Adrian W Chan, Agata Rembielak, Daniel Livesey, Matthew Chong, Zhihui Amy Liu, Mark Trombetta, Wee Yao Koh, Yiat Horng Leong, Gustavo N Marta, Pierluigi Bonomo, Viola Salvestrini, Vassilios Vassiliou, Pradnya Chopade, Partha Patel, Cindy Wong, Julie Ryan Wolf, Corina van den Hurk, Raymond J Chan, Michael Jefford, Edward Chow, Jennifer Yin Yee Kwan
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引用次数: 0

摘要

目的:本研究评估放疗(RT)技术对乳腺癌患者慢性皮肤反应和健康相关生活质量(HRQoL)的影响,比较传统RT和现代技术,如强度调制RT (IMRT)。方法:综合检索Embase、MEDLINE和Cochrane CENTRAL自成立至2024年4月26日的文献。传统的放射治疗,使用二维或三维成像来塑造没有动态强度调制的辐射束,比较了辅助乳腺癌治疗的替代放射治疗技术。主要结局包括慢性≥2级皮肤毒性(色素沉着、乳腺纤维化、毛细血管扩张、水肿和萎缩/收缩)和HRQoL,主要通过EORTC QLQ-C30和QLQ-BR23模块进行评估。采用随机效应模型计算合并风险比(RR)和95%置信区间(CI)。结果:从1305项筛选的研究中,9篇文章代表7项研究(2418例患者),包括3项随机对照试验,符合纳入标准。大多数研究使用传统的分馏法(45-50 Gray在25分)。与常规放疗相比,IMRT与慢性≥2级色素沉着的发生率较低相关(RR: 0.39, 95%CI: 0.17-0.89, I2 = 0%)。在≥2级乳腺纤维化、毛细血管扩张、水肿和萎缩/回缩方面没有发现显著差异。IMRT的美容结果在短期内是有利的,没有长期差异。结论:与常规放疗相比,IMRT可能降低某些慢性皮肤毒性。然而,没有观察到在美容结果或HRQoL方面一致的长期差异。这些发现受到研究数量少和报告标准的可变性的限制。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Chronic skin toxicities in breast cancer survivors: a systematic review and meta-analysis of radiotherapy techniques.

Purpose: This study assessed the impact of radiotherapy (RT) techniques on chronic skin reactions and health-related quality of life (HRQoL) in breast cancer patients, comparing conventional RT with modern techniques such as intensity-modulated RT (IMRT).

Methods: A comprehensive search was conducted in Embase, MEDLINE, and Cochrane CENTRAL from inception to April 26, 2024. Conventional RT, which uses 2D or 3D imaging to shape radiation beams without dynamic intensity modulation, was compared with alternate RT techniques for adjuvant breast cancer treatment. Primary outcomes included chronic grade ≥ 2 skin toxicities (hyperpigmentation, breast fibrosis, telangiectasia, edema, and atrophy/retraction) and HRQoL, assessed mainly with EORTC QLQ-C30 and QLQ-BR23 modules. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model.

Results: From 1305 screened studies, nine articles representing seven studies (2418 patients), including three randomized controlled trials, met inclusion criteria. Most studies used conventional fractionation (45-50 Gray in 25 fractions). IMRT was associated with a lower incidence of chronic grade ≥ 2 hyperpigmentation (RR: 0.39, 95%CI: 0.17-0.89, I2 = 0%) compared to conventional RT. No significant differences were found for grade ≥ 2 breast fibrosis, telangiectasia, edema, and atrophy/retraction. Cosmetic outcomes from IMRT were favorable in the short term, with no long-term differences. Three studies reported no significant HRQoL differences between IMRT and conventional RT.

Conclusion: IMRT may reduce certain chronic skin toxicities compared to conventional RT. However, consistent long-term differences in cosmetic outcomes or HRQoL were not observed. These findings are limited by the small number of studies and variability in reporting standards.

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来源期刊
CiteScore
6.80
自引率
2.60%
发文量
342
审稿时长
1 months
期刊介绍: Breast Cancer Research and Treatment provides the surgeon, radiotherapist, medical oncologist, endocrinologist, epidemiologist, immunologist or cell biologist investigating problems in breast cancer a single forum for communication. The journal creates a "market place" for breast cancer topics which cuts across all the usual lines of disciplines, providing a site for presenting pertinent investigations, and for discussing critical questions relevant to the entire field. It seeks to develop a new focus and new perspectives for all those concerned with breast cancer.
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