Systematic review of cost effectiveness intraoperative radiation therapy compares with external beam radiation therapy in breast cancer




Research Article                                                Open-Access Publishing | Gitter-Smolarz Library of <br>Life Sciences and Medicine | Tel Aviv University

American Journal of BioMedicine

Volume 11, Issue 1, 11 February 2023, Pages 22-35 | http://dx.doi.org/10.18081/2333-5106/2023.11/22
Joni A. Miller, Lian W. Parker 1*  

Received  30 September 2022   Revised  25 November 2022   Accepted  29 December 2022   Published  21 February 2023


Abstract

Breast cancer is the most common cancer and the leading cause of cancer deaths and among women worldwide. For a large proportion of women with early localized breast cancer, the recommended treatment is breast-conserving surgery (BCS) followed by postoperative radiotherapy, whole breast external-beam radiation therapy, which requires daily therapy. The purpose of this study is to analyses the cost-effectiveness of intraoperative radiation therapy (IORT) compares with external beam radiation therapy (EBRT) for early-stage breast cancer. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines used in this study. We search all articles from June 30, 2000, to June 30, 2022, in PubMed, Cochrane, ProQuest, and the Cumulative Index to Nursing, Allied Health Literature and non-English articles were excluded. We included cost-effectiveness analysis, cost-utility analysis, and cost-benefit analysis. This study included 1750 published studies, ten studies were entirely met the inclusion criteria. In six studies, IORT was associated with lower costs and higher effectiveness than EBRT. Inconclusion, IORT can be a potential cost-saving strategy to the health systems for the adjuvant treatment of breast cancer.

Keywords: Breast cancer; Breast-conserving surgery; Intraoperative radiation therapy

Copyright © 2023 Joni A. Miller, et al. This article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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1. Darby S. McGale P. et al. Early Breast Cancer Trialists' Collaborative Group. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomized trials. Lancet 2011; 378:1707-1716.
https://doi.org/10.1016/S0140-6736(11)61629-2
2. Shavers VL, Harlan LC, Stevens JL. Racial/ethnic variation in clinical presentation, treatment, and survival among breast cancer patients under age 35. Cancer 2003; 97:134-147.
https://doi.org/10.1002/cncr.11051
3. Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002; 347:1233-1241.
https://doi.org/10.1056/NEJMoa022152
4. Bradley CJ, Given CW, Roberts C. Race, socioeconomic status, and breast cancer treatment and survival. J Natl Cancer Inst 2002; 94:490-496.
https://doi.org/10.1093/jnci/94.7.490
5. Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 2002; 347:1227-1232.
https://doi.org/10.1056/NEJMoa020989
6. Clarke M, Collins R, Darby S, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 2005; 366:2087-2106.
https://doi.org/10.1016/S0140-6736(05)67887-7
7. Clegg LX, Li FP, Hankey BF, Chu K, Edwards BK. Cancer survival among US whites and minorities: a SEER (surveillance, epidemiology, and end results) program population-based study. Arch Intern Med 2002; 162:1985-1993.
https://doi.org/10.1001/archinte.162.17.1985
8. Du Xianglin L, Gor BJ. Racial disparities and trends in radiation therapy after breast-conserving surgery for early-stage breast cancer in women 1992 to 2002. Ethnicity Dis 2007; 17:122-128.
9. Aznar MC, Korreman S-S, Pedersen AN, Persson GF, Josipovic M, Specht L. Evaluation of dose to cardiac structures during breast irradiation. Br J Radiol 2011; 84:743-746.
https://doi.org/10.1259/bjr/12497075
10. Henson DE, Chu KC, Levine PH. Histologic grade, stage, and survival in breast carcinoma: comparison of Black and White women. Cancer 2003; 98:908-917.
https://doi.org/10.1002/cncr.11558
11. Veronesi U, Marubini E, Mariani L, et al. Radiotherapy after breast-conserving surgery in small breast carcinoma: long-term results of a randomized trial. Ann Oncol 2001; 12:997-1003.
https://doi.org/10.1023/A:1011136326943
12. Veronesi U, Orecchia R, Maisonneuve P, et al. Intraoperative radiotherapy versus external radiotherapy for early breast cancer (ELIOT): a randomised controlled equivalence trial. Lancet Oncol 2013; 14:1269-1277.
https://doi.org/10.1016/S1470-2045(13)70497-2
13. Jemal A, Murray T, Ward E, et al. Cancer statistics, 2005. CA Cancer J Clin 2005; 55:10-30.
https://doi.org/10.3322/canjclin.55.1.10
14. Vaidya JS, Wenz F, Bulsara M, et al. Risk-adapted targeted intraoperative radiotherapy versus whole-breast radiotherapy for breast cancer: 5-year results for local control and overall survival from the TARGIT-A randomised trial. Lancet 2014; 383:603-613.
https://doi.org/10.1016/S0140-6736(13)61950-9
15. Mandelblatt JS, Kerner JF, Hadley J, et al. Variations in breast carcinoma treatment in older Medicare beneficiaries: is it Black or White? Cancer 2002; 95:1401-1414.
https://doi.org/10.1002/cncr.10825
16. Polgar C, Fodor J, Major T, et al. Breast-conserving treatment with partial or whole breast irradiation for low-risk invasive breast carcinoma: 5-year results of a randomized trial. Int J Radiat Oncol Biol Phys 2007; 69:694-702.
https://doi.org/10.1016/j.ijrobp.2007.04.022
17. Darby SC, Ewertz M, McGale P, et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med 2013; 368:987-998.
https://doi.org/10.1056/NEJMoa1209825
18. Joslyn SA. Racial differences in treatment and survival from early-stage breast carcinoma. Cancer 2002; 95:1759-1766.
https://doi.org/10.1002/cncr.10827
19. Ares C, Khan S, MacArtain AM, et al. Postoperative proton radiotherapy for localized and locoregional breast cancer: potential for clinically relevant improvements? Int J Radiat Oncol Biol Phys 2010; 76:685-697.
https://doi.org/10.1016/j.ijrobp.2009.02.062
20. Darby S, McGale P, Correa C, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10 801 women in 17 randomised trials. Lancet 2011; 378:1707-1716.
https://doi.org/10.1016/S0140-6736(11)61629-2
21. Lohr F, El-Haddad M, Dobler B, et al. Potential effect of robust and simple IMRT approach for left-sided breast cancer on cardiac mortality. Int J Radiat Oncol Biol Phys 2009; 74:73-80.
https://doi.org/10.1016/j.ijrobp.2008.07.018
22. Smolina K, Wright FL, Rayner M, Goldacre MJ. Determinants of the decline in mortality from acute myocardial infarction in England between 2002 and 2010: linked national database study. BMJ 2012; 344:d8059-d8059.
https://doi.org/10.1136/bmj.d8059
23. Jatoi I, Becher H, Leake CR. Widening disparity in survival between White and African American patients with breast carcinoma treated in the US Department of Defense Healthcare system. Cancer 2003; 98:894-899.
https://doi.org/10.1002/cncr.11604
24. Alvarado MD, Conolly J, Park C, et al. Patient preferences regarding intraoperative versus external beam radiotherapy following breast-conserving surgery. Breast Cancer Res Treatment 2014; 143:135-140.
https://doi.org/10.1007/s10549-013-2782-9
25. Du XL, Freeman DH, Syblik DA. What drove changes in the use of breast conserving surgery for breast cancer since the early 1980s? The role of the clinical trial, celebrity action and an NIH consensus statement. Breast Cancer Res Treat 2000; 62:71-79.
https://doi.org/10.1023/A:1006414122201
26. Sperk E, Astor D, Keller A, et al. A cohort analysis to identify eligible patients for intraoperative radiotherapy (IORT) of early breast cancer. Radiat Oncol (London, England) 2014; 9:154.
https://doi.org/10.1186/1748-717X-9-154
27. Bach PB, Pham HH, Schrag D, Tate RC, Hargraves JL. Primary care physicians who treat Blacks and Whites. N Engl J Med 2004; 351:575-584.
https://doi.org/10.1056/NEJMsa040609
28. Polgar C, Van Limbergen E, Potter R, et al. Patient selection for accelerated partial-breast irradiation (APBI) after breast-conserving surgery: recommendations of the Groupe Europeen de Curietherapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) breast cancer working group based on clinical evidence. Radiother Oncol 2010; 94:264-273.
https://doi.org/10.1016/j.radonc.2010.01.014
29. Jagsi R, Moran J, Marsh R, Masi K, Griffith KA, Pierce LJ. Evaluation of four techniques using intensity-modulated radiation therapy for comprehensive locoregional irradiation of breast cancer. Int J Radiat Oncol Biol Phys 2010; 78:1594-1603.
https://doi.org/10.1016/j.ijrobp.2010.04.072
30. Vinh-Hung V, Verschraegen C. Breast-conserving surgery with or without radiotherapy: pooled-analysis for risks of ipsilateral breast tumor recurrence and mortality. J Natl Cancer Inst 2004; 96:115-121.
https://doi.org/10.1093/jnci/djh013
31. Leonardi MC, Maisonneuve P, Mastropasqua MG, et al. Accelerated partial breast irradiation with intraoperative electrons: using GEC-ESTRO recommendations as guidance for patient selection. Radiother Oncol 2013; 106:21-27.
https://doi.org/10.1016/j.radonc.2012.10.018
32. Du XL, Freeman JL, Goodwin JS. Information on radiation treatment in patients with breast cancer: the advantages of the linked Medicare and SEER data. J Clin Epidemiol 1999; 52:463-470.
https://doi.org/10.1016/S0895-4356(99)00011-6
33. Leonardi MC, Maisonneuve P, Mastropasqua MG, et al. How do the ASTRO consensus statement guidelines for the application of accelerated partial breast irradiation fit intraoperative radiotherapy? A retrospective analysis of patients treated at the European Institute of Oncology. Int J Radiat Oncol Biol Phys 2012; 83:806-813.
https://doi.org/10.1016/j.ijrobp.2011.08.014
34. Virnig BA, Warren JL, Cooper GS, Klabunde CN, Schussler N, Freeman J. Studying radiation therapy using SEER-Medicare-linked data. Med Care 2002;40(8suppl):49-54.
https://doi.org/10.1097/00005650-200208001-00007
35. Smith BD, Arthur DW, Buchholz TA, et al. Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO). Int J Radiat Oncol Biol Phys 2009; 74:987-1001.
https://doi.org/10.1016/j.ijrobp.2009.02.031
36. Early Breast Cancer Trialists' Collaborative Group. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet 2011; 378:1707-1716.
https://doi.org/10.1016/S0140-6736(11)61629-2
37. Taylor CW, Povall JM, McGale P, et al. Cardiac dose from tangential breast cancer radiotherapy in the year 2006. Int J Radiat Oncol Biol Phys 2008; 72:501-507.
https://doi.org/10.1016/j.ijrobp.2007.12.058
38. Schubert LK, Gondi V, Sengbusch E, et al. Dosimetric comparison of left-sided whole breast irradiation with 3DCRT, forward-planned IMRT, inverse-planned IMRT, helical tomotherapy, and topotherapy. Radiother Oncol 2011; 100:241-246.
https://doi.org/10.1016/j.radonc.2011.01.004

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Miller JA, Parker LW. Systematic review of cost effectiveness intraoperative radiation therapy compares with external beam radiation therapy in breast cancer. American Journal of BioMedicine 2023; 11(1):22-35.

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APA
Miller, J. A., & Parker, L. W. (2023). Systematic review of cost effectiveness intraoperative radiation therapy compares with external beam radiation therapy in breast cancer. American Journal of Biomedicine11(1), 22–35. doi:10.18081/2333-5106/2023.11/22
MLA
“Miller, Joni A., and Lian W. Parker. “Systematic Review of Cost Effectiveness Intraoperative Radiation Therapy Compares with External Beam Radiation Therapy in Breast Cancer.” American Journal of Biomedicine, vol. 11, no. 1, 2023, pp. 22–35, doi:10.18081/2333-5106/2023.11/22.
HARVARD
Miller, Joni A., and Lian W. Parker. “Systematic Review of Cost Effectiveness Intraoperative Radiation Therapy Compares with External Beam Radiation Therapy in Breast Cancer.” American Journal of Biomedicine, vol. 11, no. 1, 2023, pp. 22–35, doi:10.18081/2333-5106/2023.11/22.
VANCOUVER
Miller JA, Parker LW. Systematic review of cost effectiveness intraoperative radiation therapy compares with external beam radiation therapy in breast cancer. Am J Biomed [Internet]. 2023;11(1):22–35. Available from: http://dx.doi.org/10.18081/2333-5106/2023.11/22

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