Regional Nodal Irradiation in Early-Stage Breast Cancer
Identifieur interne : 001906 ( Main/Exploration ); précédent : 001905; suivant : 001907Regional Nodal Irradiation in Early-Stage Breast Cancer
Auteurs : 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. LevineSource :
- The New England journal of medicine [ 0028-4793 ] ; 2015.
Descripteurs français
- KwdFr :
- Adulte, Adulte d'âge moyen, Analyse de survie, Antinéoplasiques (usage thérapeutique), Association thérapeutique, Biopsie de noeud lymphatique sentinelle, Dose de radiation, Femelle, Humains, Mastectomie partielle, Métastase lymphatique (radiothérapie), Radiothérapie (effets indésirables), Risque, Récidive tumorale locale (), Stade de la tumeur, Sujet âgé, Sujet âgé de 80 ans ou plus, Tumeurs du sein (), Tumeurs du sein (mortalité), Tumeurs du sein (radiothérapie), Études de suivi.
- MESH :
- effets indésirables : Radiothérapie.
- mortalité : Tumeurs du sein.
- radiothérapie : Métastase lymphatique, Tumeurs du sein.
- usage thérapeutique : Antinéoplasiques.
- Adulte, Adulte d'âge moyen, Analyse de survie, Association thérapeutique, Biopsie de noeud lymphatique sentinelle, Dose de radiation, Femelle, Humains, Mastectomie partielle, Risque, Récidive tumorale locale, Stade de la tumeur, Sujet âgé, Sujet âgé de 80 ans ou plus, Tumeurs du sein, Études de suivi.
English descriptors
- KwdEn :
- Adult, Aged, Aged, 80 and over, Antineoplastic Agents (therapeutic use), Breast Neoplasms (mortality), Breast Neoplasms (radiotherapy), Breast Neoplasms (therapy), Combined Modality Therapy, Female, Follow-Up Studies, Humans, Lymphatic Metastasis (radiotherapy), Mastectomy, Segmental, Middle Aged, Neoplasm Recurrence, Local (prevention & control), Neoplasm Staging, Radiation Dosage, Radiotherapy (adverse effects), Risk, Sentinel Lymph Node Biopsy, Survival Analysis.
- MESH :
- chemical , therapeutic use : Antineoplastic Agents.
- adverse effects : Radiotherapy.
- mortality : Breast Neoplasms.
- prevention & control : Neoplasm Recurrence, Local.
- radiotherapy : Breast Neoplasms, Lymphatic Metastasis.
- therapy : Breast Neoplasms.
- Adult, Aged, Aged, 80 and over, Combined Modality Therapy, Female, Follow-Up Studies, Humans, Mastectomy, Segmental, Middle Aged, Neoplasm Staging, Radiation Dosage, Risk, Sentinel Lymph Node Biopsy, Survival Analysis.
Abstract
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.
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.
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).
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.
Url:
DOI: 10.1056/NEJMoa1415340
PubMed: 26200977
PubMed Central: 4556358
Affiliations:
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Whelan</name></author><author><name sortKey="Olivotto, Ivo A" sort="Olivotto, Ivo A" uniqKey="Olivotto I" first="Ivo A." last="Olivotto">Ivo A. Olivotto</name></author><author><name sortKey="Parulekar, Wendy R" sort="Parulekar, Wendy R" uniqKey="Parulekar W" first="Wendy R." last="Parulekar">Wendy R. Parulekar</name></author><author><name sortKey="Ackerman, Ida" sort="Ackerman, Ida" uniqKey="Ackerman I" first="Ida" last="Ackerman">Ida Ackerman</name></author><author><name sortKey="Chua, Boon H" sort="Chua, Boon H" uniqKey="Chua B" first="Boon H." last="Chua">Boon H. Chua</name></author><author><name sortKey="Nabid, Abdenour" sort="Nabid, Abdenour" uniqKey="Nabid A" first="Abdenour" last="Nabid">Abdenour Nabid</name></author><author><name sortKey="Vallis, Katherine A" sort="Vallis, Katherine A" uniqKey="Vallis K" first="Katherine A." last="Vallis">Katherine A. Vallis</name></author><author><name sortKey="White, Julia R" sort="White, Julia R" uniqKey="White J" first="Julia R." last="White">Julia R. White</name></author><author><name sortKey="Rousseau, Pierre" sort="Rousseau, Pierre" uniqKey="Rousseau P" first="Pierre" last="Rousseau">Pierre Rousseau</name></author><author><name sortKey="Fortin, Andre" sort="Fortin, Andre" uniqKey="Fortin A" first="Andre" last="Fortin">Andre Fortin</name></author><author><name sortKey="Pierce, Lori J" sort="Pierce, Lori J" uniqKey="Pierce L" first="Lori J." last="Pierce">Lori J. Pierce</name></author><author><name sortKey="Manchul, Lee" sort="Manchul, Lee" uniqKey="Manchul L" first="Lee" last="Manchul">Lee Manchul</name></author><author><name sortKey="Chafe, Susan" sort="Chafe, Susan" uniqKey="Chafe S" first="Susan" last="Chafe">Susan Chafe</name></author><author><name sortKey="Nolan, Maureen C" sort="Nolan, Maureen C" uniqKey="Nolan M" first="Maureen C." last="Nolan">Maureen C. Nolan</name></author><author><name sortKey="Craighead, Peter" sort="Craighead, Peter" uniqKey="Craighead P" first="Peter" last="Craighead">Peter Craighead</name></author><author><name sortKey="Bowen, Julie" sort="Bowen, Julie" uniqKey="Bowen J" first="Julie" last="Bowen">Julie Bowen</name></author><author><name sortKey="Mccready, David R" sort="Mccready, David R" uniqKey="Mccready D" first="David R." last="Mccready">David R. Mccready</name></author><author><name sortKey="Pritchard, Kathleen I" sort="Pritchard, Kathleen I" uniqKey="Pritchard K" first="Kathleen I." last="Pritchard">Kathleen I. Pritchard</name></author><author><name sortKey="Gelmon, Karen" sort="Gelmon, Karen" uniqKey="Gelmon K" first="Karen" last="Gelmon">Karen Gelmon</name></author><author><name sortKey="Murray, Yvonne" sort="Murray, Yvonne" uniqKey="Murray Y" first="Yvonne" last="Murray">Yvonne Murray</name></author><author><name sortKey="Chapman, Judy Anne W" sort="Chapman, Judy Anne W" uniqKey="Chapman J" first="Judy-Anne W." last="Chapman">Judy-Anne W. Chapman</name></author><author><name sortKey="Chen, Bingshu E" sort="Chen, Bingshu E" uniqKey="Chen B" first="Bingshu E." last="Chen">Bingshu E. Chen</name></author><author><name sortKey="Levine, Mark N" sort="Levine, Mark N" uniqKey="Levine M" first="Mark N." last="Levine">Mark N. Levine</name></author></analytic><series><title level="j">The New England journal of medicine</title><idno type="ISSN">0028-4793</idno><idno type="eISSN">1533-4406</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult</term><term>Aged</term><term>Aged, 80 and over</term><term>Antineoplastic Agents (therapeutic use)</term><term>Breast Neoplasms (mortality)</term><term>Breast Neoplasms (radiotherapy)</term><term>Breast Neoplasms (therapy)</term><term>Combined Modality Therapy</term><term>Female</term><term>Follow-Up Studies</term><term>Humans</term><term>Lymphatic Metastasis (radiotherapy)</term><term>Mastectomy, Segmental</term><term>Middle Aged</term><term>Neoplasm Recurrence, Local (prevention & control)</term><term>Neoplasm Staging</term><term>Radiation Dosage</term><term>Radiotherapy (adverse effects)</term><term>Risk</term><term>Sentinel Lymph Node Biopsy</term><term>Survival Analysis</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Analyse de survie</term><term>Antinéoplasiques (usage thérapeutique)</term><term>Association thérapeutique</term><term>Biopsie de noeud lymphatique sentinelle</term><term>Dose de radiation</term><term>Femelle</term><term>Humains</term><term>Mastectomie partielle</term><term>Métastase lymphatique (radiothérapie)</term><term>Radiothérapie (effets indésirables)</term><term>Risque</term><term>Récidive tumorale locale ()</term><term>Stade de la tumeur</term><term>Sujet âgé</term><term>Sujet âgé de 80 ans ou plus</term><term>Tumeurs du sein ()</term><term>Tumeurs du sein (mortalité)</term><term>Tumeurs du sein (radiothérapie)</term><term>Études de suivi</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Antineoplastic Agents</term></keywords><keywords scheme="MESH" qualifier="adverse effects" xml:lang="en"><term>Radiotherapy</term></keywords><keywords scheme="MESH" qualifier="effets indésirables" xml:lang="fr"><term>Radiothérapie</term></keywords><keywords scheme="MESH" qualifier="mortality" xml:lang="en"><term>Breast Neoplasms</term></keywords><keywords scheme="MESH" qualifier="mortalité" xml:lang="fr"><term>Tumeurs du sein</term></keywords><keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Neoplasm Recurrence, Local</term></keywords><keywords scheme="MESH" qualifier="radiotherapy" xml:lang="en"><term>Breast Neoplasms</term><term>Lymphatic Metastasis</term></keywords><keywords scheme="MESH" qualifier="radiothérapie" xml:lang="fr"><term>Métastase lymphatique</term><term>Tumeurs du sein</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Breast Neoplasms</term></keywords><keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Antinéoplasiques</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Aged</term><term>Aged, 80 and over</term><term>Combined Modality Therapy</term><term>Female</term><term>Follow-Up Studies</term><term>Humans</term><term>Mastectomy, Segmental</term><term>Middle Aged</term><term>Neoplasm Staging</term><term>Radiation Dosage</term><term>Risk</term><term>Sentinel Lymph Node Biopsy</term><term>Survival Analysis</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Analyse de survie</term><term>Association thérapeutique</term><term>Biopsie de noeud lymphatique sentinelle</term><term>Dose de radiation</term><term>Femelle</term><term>Humains</term><term>Mastectomie partielle</term><term>Risque</term><term>Récidive tumorale locale</term><term>Stade de la tumeur</term><term>Sujet âgé</term><term>Sujet âgé de 80 ans ou plus</term><term>Tumeurs du sein</term><term>Études de suivi</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>BACKGROUND</title><p id="P2">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.</p></sec><sec id="S2"><title>METHODS</title><p id="P3">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.</p></sec><sec id="S3"><title>RESULTS</title><p id="P4">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).</p></sec><sec id="S4"><title>CONCLUSIONS</title><p id="P5">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.</p></sec></div></front></TEI><affiliations><list></list><tree><noCountry><name sortKey="Ackerman, Ida" sort="Ackerman, Ida" uniqKey="Ackerman I" first="Ida" last="Ackerman">Ida Ackerman</name><name sortKey="Bowen, Julie" sort="Bowen, Julie" uniqKey="Bowen J" first="Julie" last="Bowen">Julie Bowen</name><name sortKey="Chafe, Susan" sort="Chafe, Susan" uniqKey="Chafe S" first="Susan" last="Chafe">Susan Chafe</name><name sortKey="Chapman, Judy Anne W" sort="Chapman, Judy Anne W" uniqKey="Chapman J" first="Judy-Anne W." last="Chapman">Judy-Anne W. Chapman</name><name sortKey="Chen, Bingshu E" sort="Chen, Bingshu E" uniqKey="Chen B" first="Bingshu E." last="Chen">Bingshu E. Chen</name><name sortKey="Chua, Boon H" sort="Chua, Boon H" uniqKey="Chua B" first="Boon H." last="Chua">Boon H. Chua</name><name sortKey="Craighead, Peter" sort="Craighead, Peter" uniqKey="Craighead P" first="Peter" last="Craighead">Peter Craighead</name><name sortKey="Fortin, Andre" sort="Fortin, Andre" uniqKey="Fortin A" first="Andre" last="Fortin">Andre Fortin</name><name sortKey="Gelmon, Karen" sort="Gelmon, Karen" uniqKey="Gelmon K" first="Karen" last="Gelmon">Karen Gelmon</name><name sortKey="Levine, Mark N" sort="Levine, Mark N" uniqKey="Levine M" first="Mark N." last="Levine">Mark N. Levine</name><name sortKey="Manchul, Lee" sort="Manchul, Lee" uniqKey="Manchul L" first="Lee" last="Manchul">Lee Manchul</name><name sortKey="Mccready, David R" sort="Mccready, David R" uniqKey="Mccready D" first="David R." last="Mccready">David R. Mccready</name><name sortKey="Murray, Yvonne" sort="Murray, Yvonne" uniqKey="Murray Y" first="Yvonne" last="Murray">Yvonne Murray</name><name sortKey="Nabid, Abdenour" sort="Nabid, Abdenour" uniqKey="Nabid A" first="Abdenour" last="Nabid">Abdenour Nabid</name><name sortKey="Nolan, Maureen C" sort="Nolan, Maureen C" uniqKey="Nolan M" first="Maureen C." last="Nolan">Maureen C. Nolan</name><name sortKey="Olivotto, Ivo A" sort="Olivotto, Ivo A" uniqKey="Olivotto I" first="Ivo A." last="Olivotto">Ivo A. Olivotto</name><name sortKey="Parulekar, Wendy R" sort="Parulekar, Wendy R" uniqKey="Parulekar W" first="Wendy R." last="Parulekar">Wendy R. Parulekar</name><name sortKey="Pierce, Lori J" sort="Pierce, Lori J" uniqKey="Pierce L" first="Lori J." last="Pierce">Lori J. Pierce</name><name sortKey="Pritchard, Kathleen I" sort="Pritchard, Kathleen I" uniqKey="Pritchard K" first="Kathleen I." last="Pritchard">Kathleen I. Pritchard</name><name sortKey="Rousseau, Pierre" sort="Rousseau, Pierre" uniqKey="Rousseau P" first="Pierre" last="Rousseau">Pierre Rousseau</name><name sortKey="Vallis, Katherine A" sort="Vallis, Katherine A" uniqKey="Vallis K" first="Katherine A." last="Vallis">Katherine A. Vallis</name><name sortKey="Whelan, Timothy J" sort="Whelan, Timothy J" uniqKey="Whelan T" first="Timothy J." last="Whelan">Timothy J. Whelan</name><name sortKey="White, Julia R" sort="White, Julia R" uniqKey="White J" first="Julia R." last="White">Julia R. White</name></noCountry></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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