Hyperthermia and radiotherapy in loco-regional recurrent breast cancers: A systematic review and meta-analysis
A partir d'une revue systématique de la littérature (34 études incluant au total 2 110 patients), cette méta-analyse évalue, du point de vue du taux de réponse complète, du contrôle local de la maladie et de la morbidité, l'intérêt d'ajouter un traitement par hyperthermie à une radiothérapie chez les patientes atteintes d'un cancer du sein ayant récidivé localement
Purpose : A systematic review and meta-analysis was conducted to evaluate the outcome of hyperthermia (HT) and radiotherapy (RT) in locally recurrent breast cancers (LRBCs). Material and methods : 708 abstracts were screened from eight databases according to the PRISMA guidelines. Single-arm and two-arm studies, treating LRBCs with HT and RT but without surgery (for local recurrence) or concurrent chemotherapy were considered. The evaluated endpoint was complete response (CR). Results : Thirty-one full text articles, pertaining to 34 studies were shortlisted for the meta-analysis. Eight were two-arm (randomized, n=5; nonrandomized, n=3) while 26 were single-arm studies. 627 patients were enrolled in two-arm and 1483 in single-arm studies. Patients were treated with a median of seven HT sessions and an average temperature of 42.5˚C was attained. Mean RT dose was 38.2 Gy (range: 26-60 Gy). HT was most frequently applied following RT. In the two-arm studies, a CR of 60.2% was achieved with RT+HT versus 38.1% with RT alone (odds ratio=2.64, 95%CI: 1.66-4.18, p<0.0001). Risk ratio and risk difference were 1.57 (95%CI: 1.25-1.96, p<0.0001) and 0.22 (95%CI: 0.11-0.33, p<0.0001) respectively. In 26 single-arm studies, RT+HT attained a CR of 63.4% (event rate=0.62, 95%CI: 0.57-0.66). Moreover, 779 patients had been previously irradiated (696 from single-arm and 83 from two-arm studies). A CR of 66.6% (event rate=0.64, 95%CI: 0.58-0.70) was achieved with HT and re-irradiation (mean +SD dose: 36.7Gy +7.7). Mean acute and late grade III/IV toxicities with RT+HT were 14.4% and 5.2% respectively. Conclusions : Thermoradiotherapy (HTRT) enhances the likelihood of CR rates in LRBCs over RT alone by 22% with minimal acute and late morbidities. For even those previously irradiated, re-irradiation with HT provides a loco-regional control in two-thirds of the patients. HTRT could therefore be considered as an effective and safe palliative treatment option for LRBCs.