Regional Nodal Irradiation in Early-Stage Breast Cancer

Whelan, Timothy J.; Olivotto, Ivo A.; Parulekar, Wendy R.; Ackerman, Ida; Chua, Boon; Nabid, Abdenour; Vallis, Katherine A.; White, Julia; Rousseau, Pierre; Fortin, A.; Pierce, Lori J.; Manchul, L.; Chafe, Susan; Nolan, Maureen; Craighead, Peter; Bowen, Julie; McCready, David R.; Pritchard, Kathleen I.; Gelmon, Karen; Murray, Yvonne; Chapman, J-Aw; Chen, Bingshu E.; Levine, Mark

doi:10.1056/nejmoa1415340

Cited by 1,097 publications

(804 citation statements)

References 20 publications

(19 reference statements)

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“…33 That study, which involved 1832 patients with node-positive or high-risk node-negative disease after breast-conserving therapy, showed that regional nodal irradiation was associated with improved disease-free survival and distant disease-free survival. The results of the study by Hennequin et al showed a lack of benefit of regional nodal irradiation; however, that study was smaller than our study and the patients had a poorer outcome (a 10% lower rate of overall survival at the 5-year follow-up and a 20% lower rate of overall survival at the 10-year follow-up).…”

Section: Discussionmentioning

confidence: 99%

Internal Mammary and Medial Supraclavicular Irradiation in Breast Cancer

Collette²,

et al. 2015

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BACKGROUND The effect of internal mammary and medial supraclavicular lymph-node irradiation (regional nodal irradiation) added to whole-breast or thoracic-wall irradiation after surgery on survival among women with early-stage breast cancer is unknown. METHODS We randomly assigned women who had a centrally or medially located primary tumor, irrespective of axillary involvement, or an externally located tumor with axillary involvement to undergo either whole-breast or thoracic-wall irradiation in addition to regional nodal irradiation (nodal-irradiation group) or whole-breast or thoracicwall irradiation alone (control group). The primary end point was overall survival. Secondary end points were the rates of disease-free survival, survival free from distant disease, and death from breast cancer. RESULTS Between 1996 and 2004, a total of 4004 patients underwent randomization. The majority of patients (76.1%) underwent breast-conserving surgery. After mastectomy, 73.4% of the patients in both groups underwent chest-wall irradiation. Nearly all patients with node-positive disease (99.0%) and 66.3% of patients with node-negative disease received adjuvant systemic treatment. At a median followup of 10.9 years, 811 patients had died. At 10 years, overall survival was 82.3% in the nodal-irradiation group and 80.7% in the control group (hazard ratio for death with nodal irradiation, 0.87; 95% confidence interval [CI], 0.76 to 1.00; P=0.06). The rate of disease-free survival was 72.1% in the nodal-irradiation group and 69.1% in the control group (hazard ratio for disease progression or death, 0.89; 95% CI, 0.80 to 1.00; P=0.04), the rate of distant disease-free survival was 78.0% versus 75.0% (hazard ratio, 0.86; 95% CI, 0.76 to 0.98; P=0.02), and breast-cancer mortality was 12.5% versus 14.4% (hazard ratio, 0.82; 95% CI, 0.70 to 0.97; P=0.02). Acute side effects of regional nodal irradiation were modest. CONCLUSIONS In patients with early-stage breast cancer, irradiation of the regional nodes had a marginal effect on overall survival. Disease-free survival and distant disease-free survival were improved, and breast-cancer mortality was reduced. (Funded by Fonds Cancer; ClinicalTrials.gov number, NCT00002851.).

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Section: Discussionmentioning

confidence: 99%

Internal Mammary and Medial Supraclavicular Irradiation in Breast Cancer

Collette²,

et al. 2015

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“…AMAROS work and posteriorly MA-20 15 presented a conflict regarding the extension of radiotherapy treatment of drainage chains 16 . In those studies, patients were submitted to specific treatment of arm pit, supra-clavicular fossa and internal mammary chains (MA-20), while Z0011 used radiotherapy only in tangent fields, in most women.…”

Section: Discussionmentioning

confidence: 99%

Fatores preditivos de metástases axilares em pacientes com câncer de mama e biópsia de linfonodo sentinela positivo

Neto

Castro

Oliveira

et al. 2017

Rev. Col. Bras. Cir.

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RESUMO Objetivo: avaliar os fatores de risco para presença de doença metastática axilar não sentinela em pacientes com câncer de mama e biópsia do linfonodo sentinela positiva. Métodos: estudo transversal, retrospectivo, de mulheres com câncer mamário operadas no Instituto do Câncer do Ceará, entre os anos de 2002 e 2012 e submetidas à biópsia de linfonodo sentinela. Resultados: de 946 pacientes com câncer de mama, 331 foram submetidas à biópsia de linfonodo sentinela, que foi positiva em 83. Estas foram submetidas à linfadenectomia axilar e 39 (46%) apresentaram metástases em outros linfonodos axilares. As variáveis que foram significantes para doença axilar adicional foram Ki67>14 (p=0,043), presença de invasão angiolinfática (p=0,01) e tamanho tumoral (p=0,027). Não foi observado associação com receptores de estrogênio, progesterona, grau tumoral e Her-2. Discussão: a presença de invasão angiolinfática e tamanho tumoral tambémjáforam relacionados à metástase axilar adicional em outros estudos. Além destas variáveis observou-se o mesmo efeito preditivo quando avaliamos o Ki67. A validação destes resultados poderá permitira customização do tratamento do câncer de mama, podendo reduzir sua morbidade. Conclusão: invasão angiolinfática, tamanho tumoral (T3/T4) e Ki67>14 foram fatores preditivos de acometimento de metástase axilar além do linfonodo sentinela.

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“…This trial of extended field adjuvant radiation after a mastectomy initially reported an impressive and significant benefit in DRFS in 2011 [11]. When the 10-year results were reported in 2015, however, the difference in OS was minimal and not significant [12]. The explanation for the failure of DRFS to predict OS remains unclear.…”

Section: Endpoints For Adjuvant Breast Cancer Trials and Eligibility mentioning

confidence: 99%

Adjuvant ovarian suppression for resected breast cancer: 2017 critical assessment

Vogl

2017

Breast Cancer Res Treat

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Currently available data supporting adjuvant ovarian function suppression for resected breast cancer in premenopausal women in addition to standard chemotherapy and tamoxifen are not persuasive, even though an ASCO guideline supports them. Available information from the key trial, called ''SOFT,'' has only 5-year followup in a 15-year disease. It employs breast cancer events as an endpoint, rather than distant metastases, or better still, death from any cause. The small advantages reported to date may disappear when aromatase inhibitors are given after the occurrence of menopause in the control population. Caution should be exercised in recommending ovarian suppression in all but the highest-risk situations.

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Regional Nodal Irradiation in Early-Stage Breast Cancer

Cited by 1,097 publications

References 20 publications

Internal Mammary and Medial Supraclavicular Irradiation in Breast Cancer

Internal Mammary and Medial Supraclavicular Irradiation in Breast Cancer

Fatores preditivos de metástases axilares em pacientes com câncer de mama e biópsia de linfonodo sentinela positivo

Adjuvant ovarian suppression for resected breast cancer: 2017 critical assessment

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