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Intraoperative radiotherapy versus no radiotherapy for early stage low-risk breast cancer patients undergoing breast-conserving surgery: a propensity score matching study based on the SEER database

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Abstract

Purpose

To compare the effect of intraoperative radiotherapy (IORT) and no radiotherapy in early stage low-risk breast cancer patients undergoing breast-conserving surgery.

Methods

According to the criteria recommended by ASTRO for patients eligible for IORT, we retrospectively selected women with early stage low-risk breast cancer who underwent breast-conserving surgery from 2010 to 2019 from the SEER database. Propensity score matching was used to balance the differences in baseline characteristics. The Kaplan–Meier method was used to calculate the overall survival (OS) and breast cancer-specific survival (BCSS) of patients, and the log-rank test was used to compare the differences.

Results

A total of 20,245 patients were included in the analysis, including 1738 in the IORT group and 18,507 in the no radiotherapy group, with a median follow-up of 41 months. Before matching, the 5-year OS rates of the IORT group and the no radiotherapy group were 95.5% and 85.7% (p < 0.001), respectively, and the 5-year BCSS rates of the two groups were 99.6% and 98.3% (p < 0.001), respectively. After matching, the 5-year OS rates were 95.6% and 90.3% (p < 0.001) in the IORT group and the no radiotherapy group, respectively, and the 5-year BCSS rates were 99.5% and 99.1% (p = 0.028), respectively. Cox multivariate analysis of the original data showed that radiotherapy was an independent prognostic factor for both OS and BCSS (p < 0.05).

Conclusions

For patients aged 50 years or older with early stage low-risk breast cancer, IORT may be a better option, with improved BCSS compared to the elimination of radiotherapy. The study could not draw conclusions on OS, because underlying diseases may be unevenly distributed between the two groups.

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Data availability

The data for this study were from the SEER database. Access to the data requires an application to SEER: https://seer.cancer.gov/.

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Acknowledgements

We thank American Journal Experts for polishing the language of this article.

Funding

This work was supported by the Joint Construction Project of Henan Medical Science and Technology Program (Grant no. LHGJ20210358).

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Authors and Affiliations

  1. Department of Radiation Oncology, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou, 450000, Henan, China

    Yin Mi, Xiaoxiao Zuo, Qinchen Cao & Yonggang Shi

  2. Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China

    Juanjuan He

  3. Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China

    Xin Sui, Jing Li & Kang Cui

  4. Department of Respiratory Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China

    Xiaoxu Ma

  5. Department of Clinical Laboratory, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China

    Nan Zhang

Authors
  1. Yin Mi
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  2. Xiaoxiao Zuo
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  3. Qinchen Cao
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  4. Juanjuan He
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  5. Xin Sui
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  7. Kang Cui
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  8. Xiaoxu Ma
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  9. Nan Zhang
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  10. Yonggang Shi
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Contributions

YM and YS contributed to the conception and design of the study. YM applied to the SEER database and obtained the data. YM, XZ, and QC extracted and collated the data. XS, JL, KC, and XM did the analysis and statistics of the data. YM wrote the manuscript. NZ, JH, and YS checked the data and revised the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yin Mi.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

Ethical approval is not required as the SEER database is a publicly available database with anonymized patients’ data. The corresponding author signed a SEER Research Data Agreement to use the data for research purposes.

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Mi, Y., Zuo, X., Cao, Q. et al. Intraoperative radiotherapy versus no radiotherapy for early stage low-risk breast cancer patients undergoing breast-conserving surgery: a propensity score matching study based on the SEER database. Clin Transl Oncol 24, 2409–2419 (2022). https://doi.org/10.1007/s12094-022-02911-x

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