Regional Nodal Irradiation in Early-Stage Breast Cancer
Timothy J Whelan, Ivo A Olivotto, Wendy R Parulekar, Ida Ackerman, Boon H Chua, Abdenour Nabid, Katherine A Vallis, Julia R White, Pierre Rousseau, Andre Fortin, Lori J Pierce, Lee Manchul, Susan Chafe, Maureen C Nolan, Peter Craighead, Julie Bowen, David R McCready, Kathleen I Pritchard, Karen Gelmon, Yvonne Murray, Judy-Anne W Chapman, Bingshu E Chen, Mark N Levine, MA.20 Study Investigators, Nancy Grant, Winkle Kwan, Carson Leong, Susan Balkwill, Don C Wilson, Hannah Carolan, Valeri Goutsouliak, Scott Tyldesley, Peter Lim, Lorna Weir, Christina F Aquino-Parsons, Gillian Campbell, Mira Keyes, Karen Gelmon, Ivo Olivotto, Pauline Truong, Elaine Wai, Hosam Kader, Paul A Blood, Skaria Alexander, Isabelle Roy, Jean-Pierre Guay, Pierre Del Vecchio, Marjory Jolicoeur, Francis Methot, Jose Ayllon, Sophie Lavertu, Marie-Andree Fortin, Pierre Rousseau, Isabelle Germain, Marie Larochelle-Beland, Isabelle Vallieres, Lucie Blondeau, Jacques Laverdiere, Anne Dagnault, Paul-Emile Raymond, Andre Fortin, James Butler, Mohamed A M Akra, Andrew L Cooke, Abdenour Nabid, Rachel Bujold, Olivier Ballivy, Gilles Prevot, Susan Chafe, Diane Severin, Alan Lees, Keith Tankel, Nirmal Mehta, Bassam Abdulkarim, John Oliver Amanie, Tirath Nijjar, Jonathan Greenland, Vasanth R Basrur, Darindra Gopaul, Timothy J Whelan, Ian S Dayes, Barbara Strang, Harold I Reiter, Jonathan Sussman, James R Wright, Sachi M Voruganti, Ian Hodson, William G McMillan, Mark Levine, Olga Vujovic, Michael I Lock, David D'Souza, Francisco Perera, Nancy Read, Edward Yu, Christine Lambert, Marie Duclos, Lorraine Portelance, Marc David, George Shenouda, David Melnychuk, Khalil Sultanem, Janice Giesbrecht, Richard H F Shao, Brian Findlay, Julie Bowen, Randall J Bissett, David Want, Sarwat Shehata, Ida Ackerman, Lawrence Paszat, Veronique Benk, Ewa Szumacher, May Tsao, Jean-Philippe Pignol, Eileen Rakovitch, Jacqueline Spayne, Gregory Czarnota, Anna Maria Wojcicka, Edward L Chow, Kathleen Pritchard, Joanne Meng, Jean-Michel Caudrelier, Laval J Grimard, Catherine Lochrin, Bhavani D Nair, Peter Cross, Dorianne Rheaume, Wladyslawa Cwajna, Robert D H Rutledge, Maureen Nolan, Ali El-Gayed, David P Skarsgard, Andree Lirette, Fernando Rojas, Linda Leblanc, Conrad Falkson, Margaret L Anthes, Peter Craighead, Theresa Trotter, Jack Mackinnon, Siraj Husain, Gregory McKinnon, Katherine Vallis, Lee Manchul, Woodrow A Wells, Anthony Fyles, Fei-Fei Liu, Wilfred Levin, John Cho, Gabrielle Kane, Anne Koch, David McCready, Malcolm Feigan, George Papadatos, Denise Lonergan, Helen Peres, Geoff Delaney, Judith Cox, Guy Bryant, Peter O'Brien, Jane Ludbrook, M Kumar, Boon Chua, David Blakey, Claire Phillips, Michelle Bishop, Sam Guglani, Roslyn Drummond, Maree Sexton, Margot Lehman, Jennifer Harvey, Raghu Gowda, Michael Penniment, Scott Carruthers, Margaret Latham, David Joseph, M Taylor, Nigel Spry, Peter Graham, Verity Ahern, David Parda, James Taylor, Berna Roig, Lorraine Champion, Rashmi Benda, Michael Kasper, Janaki Moni, Yadvindera Bains, Timothy Rearden, Carl Olson, Craig Schultz, Lawrence Berk, Mark Becker, Peter Leider, William Mueller, Julia White, Howard Zaren, R Lee, Vilija Avizonis, Ivy Petersen, Laura Vallow, Winston Tan, Steven Buskirk, Jane Ridings, John Bollinger, Nina Johnson, Alberto Daconceicao, William Casey, Michael Kuettel, Johnny Yap, Naoyuki Saito, David Pruitt, Salam Jafar, Linda Gemer, Dale Lakomy, James Herman, Susan Stinson, Steven Chmura, Lori Pierce, Oscar Streeter, Waylene Wang, Michelle Yao, Julie Soriano, Wingate Clapper, James Jones, James Richardson, Jeffrey Forman, Harry Kim, Tara Washington, Timothy J Whelan, Ivo A Olivotto, Wendy R Parulekar, Ida Ackerman, Boon H Chua, Abdenour Nabid, Katherine A Vallis, Julia R White, Pierre Rousseau, Andre Fortin, Lori J Pierce, Lee Manchul, Susan Chafe, Maureen C Nolan, Peter Craighead, Julie Bowen, David R McCready, Kathleen I Pritchard, Karen Gelmon, Yvonne Murray, Judy-Anne W Chapman, Bingshu E Chen, Mark N Levine, MA.20 Study Investigators, Nancy Grant, Winkle Kwan, Carson Leong, Susan Balkwill, Don C Wilson, Hannah Carolan, Valeri Goutsouliak, Scott Tyldesley, Peter Lim, Lorna Weir, Christina F Aquino-Parsons, Gillian Campbell, Mira Keyes, Karen Gelmon, Ivo Olivotto, Pauline Truong, Elaine Wai, Hosam Kader, Paul A Blood, Skaria Alexander, Isabelle Roy, Jean-Pierre Guay, Pierre Del Vecchio, Marjory Jolicoeur, Francis Methot, Jose Ayllon, Sophie Lavertu, Marie-Andree Fortin, Pierre Rousseau, Isabelle Germain, Marie Larochelle-Beland, Isabelle Vallieres, Lucie Blondeau, Jacques Laverdiere, Anne Dagnault, Paul-Emile Raymond, Andre Fortin, James Butler, Mohamed A M Akra, Andrew L Cooke, Abdenour Nabid, Rachel Bujold, Olivier Ballivy, Gilles Prevot, Susan Chafe, Diane Severin, Alan Lees, Keith Tankel, Nirmal Mehta, Bassam Abdulkarim, John Oliver Amanie, Tirath Nijjar, Jonathan Greenland, Vasanth R Basrur, Darindra Gopaul, Timothy J Whelan, Ian S Dayes, Barbara Strang, Harold I Reiter, Jonathan Sussman, James R Wright, Sachi M Voruganti, Ian Hodson, William G McMillan, Mark Levine, Olga Vujovic, Michael I Lock, David D'Souza, Francisco Perera, Nancy Read, Edward Yu, Christine Lambert, Marie Duclos, Lorraine Portelance, Marc David, George Shenouda, David Melnychuk, Khalil Sultanem, Janice Giesbrecht, Richard H F Shao, Brian Findlay, Julie Bowen, Randall J Bissett, David Want, Sarwat Shehata, Ida Ackerman, Lawrence Paszat, Veronique Benk, Ewa Szumacher, May Tsao, Jean-Philippe Pignol, Eileen Rakovitch, Jacqueline Spayne, Gregory Czarnota, Anna Maria Wojcicka, Edward L Chow, Kathleen Pritchard, Joanne Meng, Jean-Michel Caudrelier, Laval J Grimard, Catherine Lochrin, Bhavani D Nair, Peter Cross, Dorianne Rheaume, Wladyslawa Cwajna, Robert D H Rutledge, Maureen Nolan, Ali El-Gayed, David P Skarsgard, Andree Lirette, Fernando Rojas, Linda Leblanc, Conrad Falkson, Margaret L Anthes, Peter Craighead, Theresa Trotter, Jack Mackinnon, Siraj Husain, Gregory McKinnon, Katherine Vallis, Lee Manchul, Woodrow A Wells, Anthony Fyles, Fei-Fei Liu, Wilfred Levin, John Cho, Gabrielle Kane, Anne Koch, David McCready, Malcolm Feigan, George Papadatos, Denise Lonergan, Helen Peres, Geoff Delaney, Judith Cox, Guy Bryant, Peter O'Brien, Jane Ludbrook, M Kumar, Boon Chua, David Blakey, Claire Phillips, Michelle Bishop, Sam Guglani, Roslyn Drummond, Maree Sexton, Margot Lehman, Jennifer Harvey, Raghu Gowda, Michael Penniment, Scott Carruthers, Margaret Latham, David Joseph, M Taylor, Nigel Spry, Peter Graham, Verity Ahern, David Parda, James Taylor, Berna Roig, Lorraine Champion, Rashmi Benda, Michael Kasper, Janaki Moni, Yadvindera Bains, Timothy Rearden, Carl Olson, Craig Schultz, Lawrence Berk, Mark Becker, Peter Leider, William Mueller, Julia White, Howard Zaren, R Lee, Vilija Avizonis, Ivy Petersen, Laura Vallow, Winston Tan, Steven Buskirk, Jane Ridings, John Bollinger, Nina Johnson, Alberto Daconceicao, William Casey, Michael Kuettel, Johnny Yap, Naoyuki Saito, David Pruitt, Salam Jafar, Linda Gemer, Dale Lakomy, James Herman, Susan Stinson, Steven Chmura, Lori Pierce, Oscar Streeter, Waylene Wang, Michelle Yao, Julie Soriano, Wingate Clapper, James Jones, James Richardson, Jeffrey Forman, Harry Kim, Tara Washington
Abstract
Background: Most women with breast cancer who undergo breast-conserving surgery receive whole-breast irradiation. We examined whether the addition of regional nodal irradiation to whole-breast irradiation improved outcomes.
Methods: We randomly assigned women with node-positive or high-risk node-negative breast cancer who were treated with breast-conserving surgery and adjuvant systemic therapy to undergo either whole-breast irradiation plus regional nodal irradiation (including internal mammary, supraclavicular, and axillary lymph nodes) (nodal-irradiation group) or whole-breast irradiation alone (control group). The primary outcome was overall survival. Secondary outcomes were disease-free survival, isolated locoregional disease-free survival, and distant disease-free survival.
Results: Between March 2000 and February 2007, a total of 1832 women were assigned to the nodal-irradiation group or the control group (916 women in each group). The median follow-up was 9.5 years. At the 10-year follow-up, there was no significant between-group difference in survival, with a rate of 82.8% in the nodal-irradiation group and 81.8% in the control group (hazard ratio, 0.91; 95% confidence interval [CI], 0.72 to 1.13; P=0.38). The rates of disease-free survival were 82.0% in the nodal-irradiation group and 77.0% in the control group (hazard ratio, 0.76; 95% CI, 0.61 to 0.94; P=0.01). Patients in the nodal-irradiation group had higher rates of grade 2 or greater acute pneumonitis (1.2% vs. 0.2%, P=0.01) and lymphedema (8.4% vs. 4.5%, P=0.001).
Conclusions: Among women with node-positive or high-risk node-negative breast cancer, the addition of regional nodal irradiation to whole-breast irradiation did not improve overall survival but reduced the rate of breast-cancer recurrence. (Funded by the Canadian Cancer Society Research Institute and others; MA.20 ClinicalTrials.gov number, NCT00005957.).
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Source: PubMed