COMPLICAÇÕES LOCORREGIONAIS TARDIAS ASSOCIADAS À RADIOTERAPIA ADJUVANTE NO TRATAMENTO DO CÂNCER DE MAMA: REVISÃO SISTEMÁTICA E METANÁLISE

Introduction: Regrading the great variability of late locoregional complications associated with adjuvant radiotherapy (RT) in breast cancer, this study analyze the incidence of locoregional complications associated with adjuvant RT for breast cancer. Methods: this is a systematic review with meta-analysis according to PRISMA statement. For the comparative studies, the meta-analytic measure used was both the Odds Ratio (OR) and Relative Risk (RR) with adjustments of the fixed and random effects models. For non-comparative studies, the meta-proportion of occurrence of the event was estimated. To verify the heterogeneity of the inserted studies, we estimated the 12 statistic. Results: two-thousand one hundred seventeen papers, were identified. After exclusion of duplictes, and non-related articles, a final selection of 78 studies was made. Thirteen studies compared complications in patients undergoing surgery versus surgery and radiotherapy. A meta-analysis of 6 of these studies, which demonstrated an important statistical heterogeneity (87.8%). We identified a significant difference (p = 0.023), related to increased risk of general complications in patients undergoing RT and surgery (RR 1.86 [1:09 to 3:19]). Regarding specific complications, three main late complications were identified: lymphedema (OR 0.36, 95% CI 29-45, p <0.001, I2 84%); capsular contracture (OR 0.18, 95% CI 0.07 - 0.45, p = 0.089, I2 54% ); and upper limb movement limitation (OR 0.32 95% 0.12 - 0.84, p=0.032, 12 66%). Forty-one non-comparative studies were grouped and estimates the occurrence ratios for lymphedema (11% [7-16], p <0.001, 12 88.3%), pain (27.5% [0.18 - 0.38], p <0.001, 12 94.2%); plexopathy short (9.6% [0.3 0.02]; p <0.001, 12 97.1%); pulmonary fibrosis (12,5% [0.038 to 0.34]; p <0.001, 12 95.1%] pneumonitis (2.3% [0.008 - 0.06]; p <0.001, 12 95.8% ), breast fibrosis (33% [0.23 to 0.46]; p <0.001, 12 94.5%). Conclusions: the RR for overall chronic post-treatment complications of breast cancer associated with radiotherapy is 1.86 [1.09 - 3.19]. The main complications evaluted were lymphedema, capsular contracture and limitation of movement. It seems that radiotherapy increases the incidence of post-treatment complications, but this is not an isolated factor for the appearance of these complications. Moreover, there is a great diversity of diagnostic methodologies in different time frames, which leads to a very large discrepancy in results.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
23 October 2019