TY - JOUR
T1 - Internal Mammary and Medial Supraclavicular Irradiation in Breast Cancer
AU - Poortmans, Philip M.
AU - Collette, Sandra
AU - Kirkove, Carine
AU - van Limbergen, Erik
AU - Budach, Volker
AU - Struikmans, Henk
AU - Collette, Laurence
AU - Fourquet, Alain
AU - Maingon, Philippe
AU - Valli, Mariacarla
AU - de Winter, Karin
AU - Marnitz, Simone
AU - Barillot, Isabelle
AU - Scandolaro, Luciano
AU - Vonk, Ernest
AU - Rodenhuis, Carla
AU - Marsiglia, Hugo
AU - Weidner, Nicola
AU - van Tienhoven, Geertjan
AU - Glanzmann, Christoph
AU - Kuten, Abraham
AU - Arriagada, Rodrigo
AU - Bartelink, Harry
AU - van den Bogaert, Walter
AU - AUTHOR GROUP
AU - Oei, S. B.
AU - Scheijmans, L.
AU - Heimsoth, I.
AU - Horiot, J. C.
AU - Immerzeel, J.
AU - van de Bunt, L.
AU - Le Pechoux, C.
AU - Budach, Wilfried
AU - Bijker, N.
AU - Lutolf, U.
AU - Gez, E.
AU - Abdach, L.
AU - Campana, F.
AU - Quetin, P.
AU - Baeza, R.
AU - David, M.
AU - Jobsen, J.
AU - Sunyach, M. P.
AU - Russell, N.
AU - Mirimanoff, R. O.
AU - Matzinger, O.
AU - Bolla, M.
AU - Beauduin, M.
AU - Pfeffer, R.
AU - Lagrange, J. L.
AU - Dilhuydy, J. M.
PY - 2015
Y1 - 2015
N2 - 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 thoracic-wall 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 follow-up 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
AB - 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 thoracic-wall 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 follow-up 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
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84937830189&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/26200978
U2 - https://doi.org/10.1056/NEJMoa1415369
DO - https://doi.org/10.1056/NEJMoa1415369
M3 - Article
C2 - 26200978
SN - 0028-4793
VL - 373
SP - 317
EP - 327
JO - New England journal of medicine
JF - New England journal of medicine
IS - 4
ER -