6N Irradiation of the internal mammary and medial supraclavicular lymph node chain in stage I to III breast cancer: state of the day of EORTC phase III trial 22922/10925 with 4004 patients

Poortmans, P.; Collette, Laurence; Struikmans, H.; Bartelink, H.; Kirkove, C.; Budach, Volker; Maingon, P.; Valli, M.; Bogaert, Walter Van den

doi:10.1016/s1359-6349(10)70033-1

Cited by 27 publications

(39 citation statements)

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“…Although some studies attempted to isolate the role of rt to the im nodes 31,32 , others included additional rt to the medial supraclavicular nodes [33][34][35] or to all locoregional nodes 23,36 .…”

Section: 42mentioning

confidence: 99%

Locoregional Therapy of Locally Advanced Breast Cancer: A Clinical Practice Guideline

et al. 2015

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QuestionsIn female patients with locally advanced breast cancer (labc) and good response to neoadjuvant chemotherapy (nact), including endocrine therapy, what is the role of breast-conserving surgery (bcs) compared with mastectomy?In female patients with labc, a. is radiotherapy (rt) indicated for those who have undergone mastectomy? b. does locoregional rt, compared with breast or chest wall rt alone, result in a higher survival rate and lower recurrence rates? c. is rt indicated for those achieving a pathologic complete response (pcr) to nact?In female patients with labc who receive nact, is the most appropriate axillary staging procedure sentinel lymph node biopsy (slnb) or axillary dissection? Is slnb indicated before nact rather than at the time of surgery?How should female patients with labc that does not respond to initial nact be treated?MethodsThis guideline was developed by Cancer Care Ontario’s Program in Evidence-Based Care (pebc) and the Breast Cancer Disease Site Group (dsg). A systematic review was prepared based on literature searches conducted using the medline and embase databases for the period 1996 to December 11, 2013.Guidelines were located from that search and from the Web sites of major guideline organizations. The working group drafted recommendations based on the systemic review. The systematic review and recommendations were then circulated to the Breast Cancer dsg and the pebc Report Approval Panel for internal review; the revised document underwent external review. The full three-part evidence series can be found on the Cancer Care Ontario Web site.RecommendationsFor most patients with labc, modified radical mastectomy should be considered the standard of care. For some patients with noninflammatory labc, bcs can be considered on a case-by-case basis when the surgeon deems that the disease can be fully resected and the patient expresses a strong preference for breast preservation.For patients with labc, rt after mastectomy is recommended.It is recommended that, after bcs or mastectomy, patients with labc receive locoregional rt encompassing the breast or chest wall and local node-bearing areas.It is recommended that postoperative rt remain the standard of care for patients with labc who achieve pcr to nact.It is recommended that axillary dissection remain the standard of care for axillary staging in labc, with the judicious use of slnb in patients who are advised of the limitations of the current data.Although slnb either before or after nact is technically feasible, the data are insufficient to make any recommendation about the optimal timing of slnb with respect to nact. Limited data suggest higher sentinel lymph node identification rates and lower false negative identification rates when slnb is conducted before nact; however, those data must be balanced against the requirement for two operations if slnb is not performed at the time of resection of the main tumour.It is recommended that patients receiving neoadjuvant anthracycline–taxane-based therapy (or other sequential regimens) whose tumours do not respond to the initial agent or agents, or who experience disease progression, be expedited to the next agent or agents of the regimen.For patients who, in the opinion of the treating physician, fail to respond or progress on firstline nact, several therapeutic options can be considered, including second-line chemotherapy, hormonal therapy (if appropriate), rt, or immediate surgery (if technically feasible). Treatment should be individualized through discussion at a multidisciplinary case conference, considering tumour characteristics, patient factors and preferences, and risk of adverse effects.It is recommended that prospective randomized clinical trials be designed for patients with labc who fail to respond to nact so that more definitive treatment recommendations can be developed.

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Section: 42mentioning

confidence: 99%

Locoregional Therapy of Locally Advanced Breast Cancer: A Clinical Practice Guideline

et al. 2015

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“…Kirova). l'intérêt de la radiothérapie ganglionnaire et spécialement la chaîne mammaire interne : l'essai canadien de radiothérapie ganglionnaire après chirurgie conservatrice avec 1882 patientes et l'essai de l'European Organization for Research and Treatment of Cancer (EORTC) 22922/10925 de radiothérapie des chaînes mammaires internes et sus-claviculaires ou non (4004 patientes) [2][3][4][5]. Malgré le fait que dans l'essai canadien les auteurs aient observé une toxicité pulmonaire et des lymphoedèmes du membre supérieur, et dans celui de l'EORTC, une augmentation de la toxicité pulmonaire et cutanée (télangiectasies), sans augmentation de la toxicité cardiaque à 3 ans, la crainte principale reste l'arrivée d'une toxicité cardiaque à long terme [6][7][8][9][10].…”

Section: Introductionunclassified

État de l’art de l’irradiation des ganglions de la chaîne mammaire interne

Kirova

Almeida

Fournier-Bidoz

2015

Cancer/Radiothérapie

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“…Patients were randomized to either axillary dissection (ALND) or During the last decade, treatment trends for early breast cancer have been fluctuating between opposite extremes. More aggressive regional nodal irradiation (RNI) has been suggested by several recent studies [10,17], on the other side, the previously unquestioned dogma of axillary dissection as an important part of breast cancer management was gradually abandoned in favor of sentinel node dissection (SLND). While consensus was rapidly achieved for pathologically negative SN, the management of patients with one or two positive SN remained controversial up to the first publication of a randomized study of the American College of Surgeons Oncology Group [3] which specifically addressed the outcome of such patients with ALND vs. none.…”

mentioning

confidence: 99%

“…The EORTC 22922-10925 [10] study included 4.004 women stage with mostly pT1-2 tumors (95 %) and either involved axillary LN and/or a medially located primary tumor. Patients were randomized to receive postoperative RT either with or without RNI.…”

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confidence: 99%

How nescience may obscure evidence

et al. 2014

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limitations of the study were recognized and let to some critical comments [7], current guidelines [8,14] rapidly adopted the omission of ALND in these selected patients.Unreckoned insights about the quality of evidence generated by the Z0011-trial were provided by a recent publication on behalf of the Alliance for Clinical Trials in Oncology by Jagsi et al. Briefly, the study [3] (published in 2011) comprised 891 women from 115 institutions with a clinically negative axilla who underwent sentinel node dissection (SLND), revealing 1-2 pathologically affected nodes. Tumor characteristics were pT1 (70 %) or pT2 invasive carcinomas, mostly ER +, well-differentiated tumors. Patients were randomized to either axillary dissection (ALND) or During the last decade, treatment trends for early breast cancer have been fluctuating between opposite extremes. More aggressive regional nodal irradiation (RNI) has been suggested by several recent studies [10,17], on the other side, the previously unquestioned dogma of axillary dissection as an important part of breast cancer management was gradually abandoned in favor of sentinel node dissection (SLND). While consensus was rapidly achieved for pathologically negative SN, the management of patients with one or two positive SN remained controversial up to the first publication of a randomized study of the American College of Surgeons Oncology Group [3] which specifically addressed the outcome of such patients with ALND vs. none. Even though Editorial on Jagsi et al. Radiation field design in the ACOSOG Z0011 (Alliance) Trial.

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6N Irradiation of the internal mammary and medial supraclavicular lymph node chain in stage I to III breast cancer: state of the day of EORTC phase III trial 22922/10925 with 4004 patients

Cited by 27 publications

References 0 publications

Locoregional Therapy of Locally Advanced Breast Cancer: A Clinical Practice Guideline

Locoregional Therapy of Locally Advanced Breast Cancer: A Clinical Practice Guideline

État de l’art de l’irradiation des ganglions de la chaîne mammaire interne

How nescience may obscure evidence

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