Is radiation-induced ovarian ablation in breast cancer an obsolete procedure? Results of a meta-analysis

Figures & data

Figure 1 Schema diagram according to the quality of reporting of meta-analysis criteria.

Figure 2 Summary of risk bias assessment.

Table 1 Characteristics of studies of RT-OA in breast cancer

Study	Period	Country	Inclusion criteria	Study design	Ovarian ablation type	Radiotherapy dose and fraction size	End points	Follow-up
Adjuvant Breast Cancer Trials Collaborative Group^Citation11	1993–2000	UK, India, Sri Lanka, Egypt, Malta, Saudi Arabia, New Zealand, Pakistan, Singapore	Pre/peri menopausal women; early breast cancer; T1-3aN0-1M0	Arm A: ovarian ablation/suppression (982 patients); Arm B: control (997 patients)	Radiation, surgical oophorectomy, LHRH analogs	1,600 cGy in four fractions	Cessation of menses, PFS, OS	10 years
Boccardo et al^Citation4	1988–1992	Italy	Pre/peri menopausal women; metastatic breast cancer	Arm A: ovarian ablation (15 patients); Arm B: LHRH analogs (22 patients); Arm C: ovarian ablation + tamoxifen (18 patients); Arm D: LHRH analogs + tamoxifen (20 patients)	Radiation, surgical oophorectomy, LHRH analogs	1,500 cGy in five fractions	Cessation of menses, PFS, OS	4 years
Ejlertsen et al^Citation12	1990–1998	Denmark	Pre/peri menopausal women; early breast cancer; T1-3aN0-1M0	Arm A: ovarian ablation (317 patients); Arm B: chemotherapy CMF (445 patients)	Radiation	1,500 cGy in five fractions	Cessation of menses, PFS, OS	5 years
International Breast Cancer Study Group Trial 11-93^Citation13	1993–1998	Switzerland	Pre/peri menopausal women; early breast cancer; T1-3aN0-1M0	Arm A: ovarian ablation (37 patients); Arm B: chemotherapy AC (83 patients)	Radiation, surgical oophorectomy, LHRH analogs	1,600 cGy in four fractions, 1,500 cGy in four fractions	Cessation of menses, PFS, OS	8 years
North Central Cancer Treatment Group; Cancer and Leukemia Group B; South West Oncology Group, and Eastern Cooperative Oncology Group^Citation14	1994–1997	USA	Pre/peri menopausal women; early breast cancer; T1-3aN0-1M0	Arm A: ovarian ablation (19 patients); Arm B: tamoxifen (20 patients)	Radiation	2,000 cGy in ten fractions	Cessation of menses, PFS, OS	3 years
Scottish Cancer Trial Breast Group^Citation15	1993–1998	UK	Pre/peri menopausal women; early breast cancer; T1-3aN0-1M0	Arm A: ovarian ablation (180 patients); Arm B: tamoxifen (172 patients)	Radiation, surgical oophorectomy	4.5–5 Gy single fraction, 1,500 cGy in five fractions	Cessation of menses, PFS, OS	10 years

Abbreviations: RT-OA, radiation-induced ovarian ablation; LHRH, luteinizing hormone-releasing hormone; PFS, progression-free survival; OS, overall survival; CMF, cyclophosphamide, methotrexate, 5 Flour-uracil; AC, adriamycin, cyclophosphamide.

Figure 3 Forest plot showing amenorrhea rates for all subgroups.

Abbreviations: CLGB, Cancer and Leukemia Group B; df, degrees of freedom; RT-OA, radiation-induced ovarian ablation; M-H, Mantel-Haenszel.

Figure 4 Forest plot showing progression-free survival rates for all subgroups.

Abbreviations: CLGB, Cancer and Leukemia Group B; df, degrees of freedom; RT-OA, radiation-induced ovarian ablation; M-H, Mantel-Haenszel.

Figure 5 Forest plot showing progression-free survival rates for all subgroups.

Abbreviations: CLGB, Cancer and Leukemia Group B; df, degrees of freedom; RT-OA, radiation-induced ovarian ablation; M-H, Mantel-Haenszel.

Figure 6 Treatment fields for ovarian ablation used in included studies.

Abbreviations: L4, lumbar 4; L5, lumbar 5; SIJ, sacroiliac joint.

Figure 7 Funnel plot to evaluate publication bias.

Abbreviations: SE, standard error; OR, odds ratio.

Figure 8 (A) MR imaging fusion with CT simulation data to delineate ovaries and planning target volume and (B) Beam’s eye view.

Abbreviations: CT, computed tomography; MR, magnetic resonance.

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