Adjuvant radiation therapy of regional lymph nodes in breast cancer - a meta-analysis of randomized trials- an update
Adjuvant radiotherapy (RT) of regional lymph nodes (LN) in early breast cancer is still a matter of debate. RT increases the Overall survival (OS) rate of breast cancer patients after breast conserving surgery and after mastectomy in patients with involved LN. The contribution of RT to regional LN t...
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| Veröffentlicht in: | Radiation oncology (London, England) England), 2015-12, Vol.10 (259), p.258-258, Article 258 |
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| creator | Budach, Wilfried Bölke, Edwin Kammers, Kai Gerber, Peter Arne Nestle-Krämling, Carolin Matuschek, Christiane |
| description | Adjuvant radiotherapy (RT) of regional lymph nodes (LN) in early breast cancer is still a matter of debate. RT increases the Overall survival (OS) rate of breast cancer patients after breast conserving surgery and after mastectomy in patients with involved LN. The contribution of RT to regional LN to this improvement was poorly identified. Recently, the results of three large randomized trials addressing this question were published as full papers.
Published data of the MA.20 (n = 1832), the EORTC22922-10925 (EORTC) (n = 4004) trial and the French trial (n = 1334) were the foundation of this meta-analysis. Major eligibility criteria were positive i) axillary LN (all trials), ii) LN negative disease with high risk for recurrence (MA.20), and iii) medial/central tumor location (French, EORTC). The MA.20 and the EORTC trial analyzed the effect of additional regional RT to the internal mammary (IM) LN and medial supraclavicular (MS) LN, whereas in the French trial all patients received RT to the MS-LN and solely RT to the IM-LN was randomized. Primary endpoint was OS. Secondary endpoints were disease-free survival (DFS) and distant metastasis free survival (DMFS).
Regional RT of MS-LN and IM-LN (MA.20 and EORTC) resulted in a significant improvement of OS [Hazard Ratio (HR) 0.88 (95 % CL 0.78 - 0.99)]. Adding results of the French trial and using a random effects model to respect the different design of the French trial, the effect on OS of regional RT remained significant [HR 0.90 (95 % CL 0.82 - 0.99)]. The absolute benefits in OS were 1 % in the MA.20 trial at 10 years, 1.6 % in the EORTC trial at 10 years, and 3.3 % in the French trial at 10 years (not significant in single trials). Regional RT of MS-LN and IM-LN (MA.20 and EORTC) yielded to a significant improvement of DFS [HR 0.86 (95 % CL 0.78 - 0.95)] and DMFS [HR 0.84 (95 % CL 0.75 - 0.94)].
Additional regional RT to the internal mammary and medial supraclavicular LN statistically significantly improved DFS, DMFS, and OS in stage I-III breast cancer. |
| doi_str_mv | 10.1186/s13014-015-0568-4 |
| format | Article |
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Published data of the MA.20 (n = 1832), the EORTC22922-10925 (EORTC) (n = 4004) trial and the French trial (n = 1334) were the foundation of this meta-analysis. Major eligibility criteria were positive i) axillary LN (all trials), ii) LN negative disease with high risk for recurrence (MA.20), and iii) medial/central tumor location (French, EORTC). The MA.20 and the EORTC trial analyzed the effect of additional regional RT to the internal mammary (IM) LN and medial supraclavicular (MS) LN, whereas in the French trial all patients received RT to the MS-LN and solely RT to the IM-LN was randomized. Primary endpoint was OS. Secondary endpoints were disease-free survival (DFS) and distant metastasis free survival (DMFS).
Regional RT of MS-LN and IM-LN (MA.20 and EORTC) resulted in a significant improvement of OS [Hazard Ratio (HR) 0.88 (95 % CL 0.78 - 0.99)]. Adding results of the French trial and using a random effects model to respect the different design of the French trial, the effect on OS of regional RT remained significant [HR 0.90 (95 % CL 0.82 - 0.99)]. The absolute benefits in OS were 1 % in the MA.20 trial at 10 years, 1.6 % in the EORTC trial at 10 years, and 3.3 % in the French trial at 10 years (not significant in single trials). Regional RT of MS-LN and IM-LN (MA.20 and EORTC) yielded to a significant improvement of DFS [HR 0.86 (95 % CL 0.78 - 0.95)] and DMFS [HR 0.84 (95 % CL 0.75 - 0.94)].
Additional regional RT to the internal mammary and medial supraclavicular LN statistically significantly improved DFS, DMFS, and OS in stage I-III breast cancer.</description><identifier>ISSN: 1748-717X</identifier><identifier>EISSN: 1748-717X</identifier><identifier>DOI: 10.1186/s13014-015-0568-4</identifier><identifier>PMID: 26691175</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Analysis ; Breast cancer ; Breast Neoplasms - mortality ; Breast Neoplasms - pathology ; Breast Neoplasms - radiotherapy ; Cancer therapies ; Confidence intervals ; Disease-Free Survival ; Estimates ; Female ; Humans ; Lymphatic Metastasis - prevention & control ; Lymphatic system ; Meta-analysis ; Metastasis ; Oncology ; Radiation ; Radiation therapy ; Radiotherapy ; Radiotherapy, Adjuvant - methods ; Randomized Controlled Trials as Topic ; Ratios ; Statistical analysis ; Studies ; Tumors</subject><ispartof>Radiation oncology (London, England), 2015-12, Vol.10 (259), p.258-258, Article 258</ispartof><rights>COPYRIGHT 2015 BioMed Central Ltd.</rights><rights>Copyright BioMed Central 2015</rights><rights>Budach et al. 2015</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c564t-c07b96ec304e240fc686ef9d40eaac3f168993053061b5a4fc485ae0d80cbad3</citedby><cites>FETCH-LOGICAL-c564t-c07b96ec304e240fc686ef9d40eaac3f168993053061b5a4fc485ae0d80cbad3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4687086/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4687086/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,725,778,782,862,883,27907,27908,53774,53776</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26691175$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Budach, Wilfried</creatorcontrib><creatorcontrib>Bölke, Edwin</creatorcontrib><creatorcontrib>Kammers, Kai</creatorcontrib><creatorcontrib>Gerber, Peter Arne</creatorcontrib><creatorcontrib>Nestle-Krämling, Carolin</creatorcontrib><creatorcontrib>Matuschek, Christiane</creatorcontrib><title>Adjuvant radiation therapy of regional lymph nodes in breast cancer - a meta-analysis of randomized trials- an update</title><title>Radiation oncology (London, England)</title><addtitle>Radiat Oncol</addtitle><description>Adjuvant radiotherapy (RT) of regional lymph nodes (LN) in early breast cancer is still a matter of debate. RT increases the Overall survival (OS) rate of breast cancer patients after breast conserving surgery and after mastectomy in patients with involved LN. The contribution of RT to regional LN to this improvement was poorly identified. Recently, the results of three large randomized trials addressing this question were published as full papers.
Published data of the MA.20 (n = 1832), the EORTC22922-10925 (EORTC) (n = 4004) trial and the French trial (n = 1334) were the foundation of this meta-analysis. Major eligibility criteria were positive i) axillary LN (all trials), ii) LN negative disease with high risk for recurrence (MA.20), and iii) medial/central tumor location (French, EORTC). The MA.20 and the EORTC trial analyzed the effect of additional regional RT to the internal mammary (IM) LN and medial supraclavicular (MS) LN, whereas in the French trial all patients received RT to the MS-LN and solely RT to the IM-LN was randomized. Primary endpoint was OS. Secondary endpoints were disease-free survival (DFS) and distant metastasis free survival (DMFS).
Regional RT of MS-LN and IM-LN (MA.20 and EORTC) resulted in a significant improvement of OS [Hazard Ratio (HR) 0.88 (95 % CL 0.78 - 0.99)]. Adding results of the French trial and using a random effects model to respect the different design of the French trial, the effect on OS of regional RT remained significant [HR 0.90 (95 % CL 0.82 - 0.99)]. The absolute benefits in OS were 1 % in the MA.20 trial at 10 years, 1.6 % in the EORTC trial at 10 years, and 3.3 % in the French trial at 10 years (not significant in single trials). Regional RT of MS-LN and IM-LN (MA.20 and EORTC) yielded to a significant improvement of DFS [HR 0.86 (95 % CL 0.78 - 0.95)] and DMFS [HR 0.84 (95 % CL 0.75 - 0.94)].
Additional regional RT to the internal mammary and medial supraclavicular LN statistically significantly improved DFS, DMFS, and OS in stage I-III breast cancer.</description><subject>Analysis</subject><subject>Breast cancer</subject><subject>Breast Neoplasms - mortality</subject><subject>Breast Neoplasms - pathology</subject><subject>Breast Neoplasms - radiotherapy</subject><subject>Cancer therapies</subject><subject>Confidence intervals</subject><subject>Disease-Free Survival</subject><subject>Estimates</subject><subject>Female</subject><subject>Humans</subject><subject>Lymphatic Metastasis - prevention & control</subject><subject>Lymphatic system</subject><subject>Meta-analysis</subject><subject>Metastasis</subject><subject>Oncology</subject><subject>Radiation</subject><subject>Radiation therapy</subject><subject>Radiotherapy</subject><subject>Radiotherapy, Adjuvant - methods</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Ratios</subject><subject>Statistical analysis</subject><subject>Studies</subject><subject>Tumors</subject><issn>1748-717X</issn><issn>1748-717X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNptkkFv3CAQha2qUZOm_QG9VEi99OIUYgz4UmkVNW2lSLnkkBsaw3iXlQ0u4EjbX182m6ZJFXEADd97aIZXVR8YPWNMiS-JNZTxmrK2pq1QNX9VnTDJVS2ZvH395HxcvU1pSylvG9q9qY7PhegYk-1JtazsdrkDn0kE6yC74EneYIR5R8JAIq5LBUYy7qZ5Q3ywmIjzpI8IKRMD3mAkNQEyYYYaCrpLLt1Lwdswud9oSY4OxlQoT5bZQsZ31dFQKvj-YT-tbi6_3Vz8qK-uv_-8WF3VphU814bKvhNoGsrxnNPBCCVw6CynCGCagQnVdQ0tTQnWt8AHw1ULSK2ipgfbnFZfD7bz0k9oDfocYdRzdBPEnQ7g9PMb7zZ6He40F0pSJYrB5weDGH4tmLKeXDI4juAxLEmXETKuZCtVQT_9h27DEss89pTsBKOSin_UGkbUzg-hvGv2pnrFW1a-RSlZqLMXqLIsTs4Ej4Mr9WcCdhCYGFKKODz2yKjeR0UfoqJLVPQ-KpoXzcenw3lU_M1G8wdZSrpp</recordid><startdate>20151221</startdate><enddate>20151221</enddate><creator>Budach, Wilfried</creator><creator>Bölke, Edwin</creator><creator>Kammers, Kai</creator><creator>Gerber, Peter Arne</creator><creator>Nestle-Krämling, Carolin</creator><creator>Matuschek, Christiane</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>P64</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20151221</creationdate><title>Adjuvant radiation therapy of regional lymph nodes in breast cancer - a meta-analysis of randomized trials- an update</title><author>Budach, Wilfried ; 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RT increases the Overall survival (OS) rate of breast cancer patients after breast conserving surgery and after mastectomy in patients with involved LN. The contribution of RT to regional LN to this improvement was poorly identified. Recently, the results of three large randomized trials addressing this question were published as full papers.
Published data of the MA.20 (n = 1832), the EORTC22922-10925 (EORTC) (n = 4004) trial and the French trial (n = 1334) were the foundation of this meta-analysis. Major eligibility criteria were positive i) axillary LN (all trials), ii) LN negative disease with high risk for recurrence (MA.20), and iii) medial/central tumor location (French, EORTC). The MA.20 and the EORTC trial analyzed the effect of additional regional RT to the internal mammary (IM) LN and medial supraclavicular (MS) LN, whereas in the French trial all patients received RT to the MS-LN and solely RT to the IM-LN was randomized. Primary endpoint was OS. Secondary endpoints were disease-free survival (DFS) and distant metastasis free survival (DMFS).
Regional RT of MS-LN and IM-LN (MA.20 and EORTC) resulted in a significant improvement of OS [Hazard Ratio (HR) 0.88 (95 % CL 0.78 - 0.99)]. Adding results of the French trial and using a random effects model to respect the different design of the French trial, the effect on OS of regional RT remained significant [HR 0.90 (95 % CL 0.82 - 0.99)]. The absolute benefits in OS were 1 % in the MA.20 trial at 10 years, 1.6 % in the EORTC trial at 10 years, and 3.3 % in the French trial at 10 years (not significant in single trials). Regional RT of MS-LN and IM-LN (MA.20 and EORTC) yielded to a significant improvement of DFS [HR 0.86 (95 % CL 0.78 - 0.95)] and DMFS [HR 0.84 (95 % CL 0.75 - 0.94)].
Additional regional RT to the internal mammary and medial supraclavicular LN statistically significantly improved DFS, DMFS, and OS in stage I-III breast cancer.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>26691175</pmid><doi>10.1186/s13014-015-0568-4</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Analysis Breast cancer Breast Neoplasms - mortality Breast Neoplasms - pathology Breast Neoplasms - radiotherapy Cancer therapies Confidence intervals Disease-Free Survival Estimates Female Humans Lymphatic Metastasis - prevention & control Lymphatic system Meta-analysis Metastasis Oncology Radiation Radiation therapy Radiotherapy Radiotherapy, Adjuvant - methods Randomized Controlled Trials as Topic Ratios Statistical analysis Studies Tumors |
| title | Adjuvant radiation therapy of regional lymph nodes in breast cancer - a meta-analysis of randomized trials- an update |
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