Ten-Year Survival Results of a Randomized Trial of Irradiation of Internal Mammary Nodes After Mastectomy

Hennequin, Christophe; Bossard, Nadine; Servagi-Vernat, S.; Maingon, P.; Dubois, Jean‐Bernard; Datchary, Jean; Carrié, C.; Roullet, Bernard; Suchaud, Jean-Philippe; Teissier, É.; Lucardi, Audrey; Gérard, Jean-Pierre; Belot, Aurélien; Iwaz, Jean; Écochard, René; Romestaing, P.

doi:10.1016/j.ijrobp.2013.03.021

Cited by 233 publications

(133 citation statements)

References 30 publications

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“…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). 34 We found a low rate of heart disease and death from heart disease after 10.9 years of follow-up, as has been reported before. 17,34 However, Darby et al found a dose-dependent increased risk of late ischemic heart disease associated with radiotherapy for cancer of the left breast.…”

Section: Discussionsupporting

confidence: 87%

“…34 We found a low rate of heart disease and death from heart disease after 10.9 years of follow-up, as has been reported before. 17,34 However, Darby et al found a dose-dependent increased risk of late ischemic heart disease associated with radiotherapy for cancer of the left breast. 28 Cardiac disease after radiation therapy might have onset early after treatment.…”

Section: Discussionsupporting

confidence: 87%

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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: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 87%

Internal Mammary and Medial Supraclavicular Irradiation in Breast Cancer

Collette²,

et al. 2015

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“…However, the study has not enough statistical power to detect differences smaller than 10%. 7 The others, still unpublished, evaluate the inclusion of IMC and medial supraclavicular chain in the treatment fields (EORTC 22922/10925), assess the impact of regional irradiation (supraclavicular, axillary and IMC) on early invasive breast cancer (NCIC MA.20), and randomize patients to irradiate or not the IMN (KROG-0806).…”

Section: Discussionmentioning

confidence: 99%

“…A clinical study with a larger number of patients and that addresses this issue directly would help in understanding the real benefit of the unintended irradiation of IMC, and may even explain the absence of clinical benefit observed in previous studies that evaluated the intentional irradiation of this region. 7 …”

Section: Discussionmentioning

confidence: 99%

“…3 However, irradiation of the IMC is still a matter of much debate, 3,4 because even with a high incidence of pathological involvement of this nodal region, 5 there are low rates of recurrence at this region even when not irradiated. 6 While the results of most prospective randomized trials that assess the benefits of IMC irradiation have not yet been published (NCT00005957, NCT00002851), therapeutic decisions are guided by one prospective study, 7 some retrospective series evaluating both oncological outcomes and clinical toxicity, 6,8,9 or even dosimetric studies. 10 The controversy regarding its potential benefit leads to differences in the profile of the IMC irradiation indication in different geographical regions worldwide, 11,12 with arguments both for and against intentional inclusion of IMC in the irradiation fields.…”

Section: Introductionmentioning

confidence: 99%

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Unintended irradiation of internal mammary chain – Is that enough?

Sapienza

Chen

Gomes

et al. 2016

Reports of Practical Oncology & Radiotherapy

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Postoperative Radiotherapy After Breast-Conserving Surgery for Early-Stage Breast Cancer

Speers

Pierce

2016

JAMA Oncol

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Adjuvant RT in early-stage breast cancer significantly reduces in-breast tumor recurrence and improves overall survival. Although risk reductions observed in randomized trials have been relatively consistent across series, the absolute benefit of RT is not equal for all women. Efforts are under way to identify which patients benefit the most from local or locoregional RT vs those at very low risk for recurrence in whom RT can be omitted. For patients who will benefit from RT and are appropriate candidates, hypofractionated RT should be strongly considered.

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Ten-Year Survival Results of a Randomized Trial of Irradiation of Internal Mammary Nodes After Mastectomy

Cited by 233 publications

References 30 publications

Internal Mammary and Medial Supraclavicular Irradiation in Breast Cancer

Internal Mammary and Medial Supraclavicular Irradiation in Breast Cancer

Unintended irradiation of internal mammary chain – Is that enough?

Postoperative Radiotherapy After Breast-Conserving Surgery for Early-Stage Breast Cancer

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