Internal Mammary, Medial Supraclavicular Irradiation in Breast Cancer Evaluated

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Patients with early-stage breast cancer who received irradiation of the regional nodes showed a marginal effect on overall survival.
Patients with early-stage breast cancer who received irradiation of the regional nodes showed a marginal effect on overall survival.

Patients with early-stage breast cancer who received irradiation of the regional nodes showed a marginal effect on overall survival, but improved disease-free survival, distant disease-free survival, and decreased breast cancer mortality, according to an article published online ahead of print in The New England Journal of Medicine.

Researchers randomly assigned 4004 patients with a centrally or medially located primary tumor or an externally-based tumor with axillary involvement to 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).

Most patients (76.1%) underwent breast-conserving surgery. After mastectomy, 73.4% of patients in both groups underwent chest-wall irradiation.

Almost all patients with node-positive disease (99%) and 66.3% of patients with node-negative disease received adjuvant 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 (P=0.06).

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Disease-free survival was 72.1% in the nodal irradiation group and 69.1% in the control group. Distant disease-free survival was 78.0% versus 75.0%, and breast cancer mortality was 12.5% versus 14.4%

In regard to safety, acute side effects of regional nodal irradiation were modest.

Reference

  1. Poortmans PM, Collette S, Kirkove C, et al. Internal mammary and medial supraclavicular irradiation in breast cancer. N Engl J Med. [epub ahead of print]. 2015. doi: 10.1056/NEJMoa1415369.

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