Adjuvant radiation therapy of regional lymph nodes in breast cancer - a meta-analysis of randomized trials- an update
Identifieur interne : 002176 ( Main/Exploration ); précédent : 002175; suivant : 002177Adjuvant radiation therapy of regional lymph nodes in breast cancer - a meta-analysis of randomized trials- an update
Auteurs : Wilfried Budach [Allemagne] ; Edwin Bölke [Allemagne] ; Kai Kammers [États-Unis] ; Peter Arne Gerber [Allemagne] ; Carolin Nestle-Kr Mling [Allemagne] ; Christiane Matuschek [Allemagne]Source :
- Radiation Oncology (London, England) [ 1748-717X ] ; 2015.
Abstract
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 (
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.
Url:
DOI: 10.1186/s13014-015-0568-4
PubMed: 26691175
PubMed Central: 4687086
Affiliations:
- Allemagne, États-Unis
- District de Düsseldorf, Maryland, Rhénanie-du-Nord-Westphalie
- Baltimore, Düsseldorf
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nuts="1">Rhénanie-du-Nord-Westphalie</region><region type="district" nuts="2">District de Düsseldorf</region><settlement type="city">Düsseldorf</settlement></placeName></affiliation></author><author><name sortKey="Bolke, Edwin" sort="Bolke, Edwin" uniqKey="Bolke E" first="Edwin" last="Bölke">Edwin Bölke</name><affiliation wicri:level="3"><nlm:aff id="Aff1">Department of Radiation Oncology, Medical Faculty, Heinrich Heine University, Dusseldorf, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Radiation Oncology, Medical Faculty, Heinrich Heine University, Dusseldorf</wicri:regionArea><placeName><region type="land" nuts="1">Rhénanie-du-Nord-Westphalie</region><region type="district" nuts="2">District de Düsseldorf</region><settlement type="city">Düsseldorf</settlement></placeName></affiliation></author><author><name sortKey="Kammers, Kai" sort="Kammers, Kai" uniqKey="Kammers K" first="Kai" last="Kammers">Kai Kammers</name><affiliation wicri:level="3"><nlm:aff id="Aff2">Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore</wicri:regionArea><placeName><settlement type="city">Baltimore</settlement><region type="state">Maryland</region></placeName></affiliation></author><author><name sortKey="Gerber, Peter Arne" sort="Gerber, Peter Arne" uniqKey="Gerber P" first="Peter Arne" last="Gerber">Peter Arne Gerber</name><affiliation wicri:level="1"><nlm:aff id="Aff3">Department of Dermatology, Medical Faculty, Heinrich Heine University, Duesseldorf, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Dermatology, Medical Faculty, Heinrich Heine University, Duesseldorf</wicri:regionArea><wicri:noRegion>Duesseldorf</wicri:noRegion><wicri:noRegion>Duesseldorf</wicri:noRegion><wicri:noRegion>Duesseldorf</wicri:noRegion></affiliation></author><author><name sortKey="Nestle Kr Mling, Carolin" sort="Nestle Kr Mling, Carolin" uniqKey="Nestle Kr Mling C" first="Carolin" last="Nestle-Kr Mling">Carolin Nestle-Kr Mling</name><affiliation wicri:level="3"><nlm:aff id="Aff4">Department of Senology, Sana Krankenhaus Gerresheim, Dusseldorf, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Senology, Sana Krankenhaus Gerresheim, Dusseldorf</wicri:regionArea><placeName><region type="land" nuts="1">Rhénanie-du-Nord-Westphalie</region><region type="district" nuts="2">District de Düsseldorf</region><settlement type="city">Düsseldorf</settlement></placeName></affiliation></author><author><name sortKey="Matuschek, Christiane" sort="Matuschek, Christiane" uniqKey="Matuschek C" first="Christiane" last="Matuschek">Christiane Matuschek</name><affiliation wicri:level="3"><nlm:aff id="Aff1">Department of Radiation Oncology, Medical Faculty, Heinrich Heine University, Dusseldorf, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Radiation Oncology, Medical Faculty, Heinrich Heine University, Dusseldorf</wicri:regionArea><placeName><region type="land" nuts="1">Rhénanie-du-Nord-Westphalie</region><region type="district" nuts="2">District de Düsseldorf</region><settlement type="city">Düsseldorf</settlement></placeName></affiliation></author></analytic><series><title level="j">Radiation Oncology (London, England)</title><idno type="eISSN">1748-717X</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>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.</p></sec><sec><title>Material and methods</title><p>Published data of the MA.20 (<italic>n</italic> = 1832), the EORTC22922–10925 (EORTC) (<italic>n</italic> = 4004) trial and the French trial (<italic>n</italic> = 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).</p></sec><sec><title>Results</title><p>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)].</p></sec><sec><title>Conclusion</title><p>Additional regional RT to the internal mammary and medial supraclavicular LN statistically significantly improved DFS, DMFS, and OS in stage I-III breast cancer.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Budach, W" uniqKey="Budach W">W Budach</name></author><author><name sortKey="Matuschek, C" uniqKey="Matuschek C">C Matuschek</name></author><author><name sortKey="Bolke, E" uniqKey="Bolke E">E Bolke</name></author><author><name sortKey="Dunst, J" uniqKey="Dunst J">J Dunst</name></author><author><name sortKey="Feyer, P" uniqKey="Feyer P">P Feyer</name></author><author><name sortKey="Fietkau, R" uniqKey="Fietkau R">R Fietkau</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bourgier, C" uniqKey="Bourgier C">C Bourgier</name></author><author><name sortKey="Aimard, L" uniqKey="Aimard L">L Aimard</name></author><author><name sortKey="Bodez, V" uniqKey="Bodez V">V Bodez</name></author><author><name sortKey="Bollet, Ma" uniqKey="Bollet M">MA Bollet</name></author><author><name sortKey="Cutuli, B" uniqKey="Cutuli B">B Cutuli</name></author><author><name sortKey="Franck, D" uniqKey="Franck D">D Franck</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Overgaard, M" uniqKey="Overgaard M">M Overgaard</name></author><author><name sortKey="Jensen, Mb" uniqKey="Jensen M">MB Jensen</name></author><author><name sortKey="Overgaard, J" uniqKey="Overgaard J">J Overgaard</name></author><author><name sortKey="Hansen, Ps" uniqKey="Hansen P">PS Hansen</name></author><author><name sortKey="Rose, C" uniqKey="Rose C">C Rose</name></author><author><name sortKey="Andersson, M" uniqKey="Andersson M">M Andersson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Clarke, M" uniqKey="Clarke M">M Clarke</name></author><author><name sortKey="Collins, R" uniqKey="Collins R">R Collins</name></author><author><name sortKey="Darby, S" uniqKey="Darby S">S Darby</name></author><author><name sortKey="Davies, C" uniqKey="Davies C">C Davies</name></author><author><name sortKey="Elphinstone, P" uniqKey="Elphinstone P">P Elphinstone</name></author><author><name sortKey="Evans, V" uniqKey="Evans V">V Evans</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Darby, S" uniqKey="Darby S">S Darby</name></author><author><name sortKey="Mcgale, P" uniqKey="Mcgale P">P McGale</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kyndi, M" uniqKey="Kyndi M">M Kyndi</name></author><author><name sortKey="Sorensen, Fb" uniqKey="Sorensen F">FB Sorensen</name></author><author><name sortKey="Knudsen, H" uniqKey="Knudsen H">H Knudsen</name></author><author><name sortKey="Alsner, J" uniqKey="Alsner J">J Alsner</name></author><author><name sortKey="Overgaard, M" uniqKey="Overgaard M">M Overgaard</name></author><author><name sortKey="Nielsen, Hm" uniqKey="Nielsen H">HM Nielsen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Budach, W" uniqKey="Budach W">W Budach</name></author><author><name sortKey="Kammers, K" uniqKey="Kammers K">K Kammers</name></author><author><name sortKey="Boelke, E" uniqKey="Boelke E">E Boelke</name></author><author><name sortKey="Matuschek, C" uniqKey="Matuschek C">C Matuschek</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lievens, Y" uniqKey="Lievens Y">Y Lievens</name></author><author><name sortKey="Van Den Bogaert, W" uniqKey="Van Den Bogaert W">W Van den Bogaert</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Matzinger, O" uniqKey="Matzinger O">O Matzinger</name></author><author><name sortKey="Heimsoth, I" uniqKey="Heimsoth I">I Heimsoth</name></author><author><name sortKey="Poortmans, P" uniqKey="Poortmans P">P Poortmans</name></author><author><name sortKey="Collette, L" uniqKey="Collette L">L Collette</name></author><author><name sortKey="Struikmans, H" uniqKey="Struikmans H">H Struikmans</name></author><author><name sortKey="Van Den Bogaert, W" uniqKey="Van Den Bogaert W">W Van Den Bogaert</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Whelan, Tj" uniqKey="Whelan T">TJ Whelan</name></author><author><name sortKey="Olivotto, Ia" uniqKey="Olivotto I">IA Olivotto</name></author><author><name sortKey="Parulekar, Wr" uniqKey="Parulekar W">WR Parulekar</name></author><author><name sortKey="Ackerman, I" uniqKey="Ackerman I">I Ackerman</name></author><author><name sortKey="Chua, Bh" uniqKey="Chua B">BH Chua</name></author><author><name sortKey="Nabid, A" uniqKey="Nabid A">A Nabid</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Poortmans, Pm" uniqKey="Poortmans P">PM Poortmans</name></author><author><name sortKey="Collette, S" uniqKey="Collette S">S Collette</name></author><author><name sortKey="Kirkove, C" uniqKey="Kirkove C">C Kirkove</name></author><author><name sortKey="Van Limbergen, E" uniqKey="Van Limbergen E">E Van Limbergen</name></author><author><name sortKey="Budach, V" uniqKey="Budach V">V Budach</name></author><author><name sortKey="Struikmans, H" uniqKey="Struikmans H">H Struikmans</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Poortmans, P" uniqKey="Poortmans P">P Poortmans</name></author><author><name sortKey="Kouloulias, V" uniqKey="Kouloulias V">V Kouloulias</name></author><author><name sortKey="Van Tienhoven, G" uniqKey="Van Tienhoven G">G van Tienhoven</name></author><author><name sortKey="Collette, L" uniqKey="Collette L">L Collette</name></author><author><name sortKey="Struikmans, H" uniqKey="Struikmans H">H Struikmans</name></author><author><name sortKey="Venselaar, Jl" uniqKey="Venselaar J">JL Venselaar</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hennequin, C" uniqKey="Hennequin C">C Hennequin</name></author><author><name sortKey="Bossard, N" uniqKey="Bossard N">N Bossard</name></author><author><name sortKey="Servagi Vernat, S" uniqKey="Servagi Vernat S">S Servagi-Vernat</name></author><author><name sortKey="Maingon, P" uniqKey="Maingon P">P Maingon</name></author><author><name sortKey="Dubois, Jb" uniqKey="Dubois J">JB Dubois</name></author><author><name sortKey="Datchary, J" uniqKey="Datchary J">J Datchary</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Parmar, Mk" uniqKey="Parmar M">MK Parmar</name></author><author><name sortKey="Torri, V" uniqKey="Torri V">V Torri</name></author><author><name sortKey="Stewart, L" uniqKey="Stewart L">L Stewart</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kyndi, M" uniqKey="Kyndi M">M Kyndi</name></author><author><name sortKey="Sorensen, Fb" uniqKey="Sorensen F">FB Sorensen</name></author><author><name sortKey="Knudsen, H" uniqKey="Knudsen H">H Knudsen</name></author><author><name sortKey="Overgaard, M" uniqKey="Overgaard M">M Overgaard</name></author><author><name sortKey="Nielsen, Hm" uniqKey="Nielsen H">HM Nielsen</name></author><author><name sortKey="Overgaard, J" uniqKey="Overgaard J">J Overgaard</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Allemagne</li><li>États-Unis</li></country><region><li>District de Düsseldorf</li><li>Maryland</li><li>Rhénanie-du-Nord-Westphalie</li></region><settlement><li>Baltimore</li><li>Düsseldorf</li></settlement></list><tree><country name="Allemagne"><region name="Rhénanie-du-Nord-Westphalie"><name sortKey="Budach, Wilfried" sort="Budach, Wilfried" uniqKey="Budach W" first="Wilfried" last="Budach">Wilfried Budach</name></region><name sortKey="Bolke, Edwin" sort="Bolke, Edwin" uniqKey="Bolke E" first="Edwin" last="Bölke">Edwin Bölke</name><name sortKey="Gerber, Peter Arne" sort="Gerber, Peter Arne" uniqKey="Gerber P" first="Peter Arne" last="Gerber">Peter Arne Gerber</name><name sortKey="Matuschek, Christiane" sort="Matuschek, Christiane" uniqKey="Matuschek C" first="Christiane" last="Matuschek">Christiane Matuschek</name><name sortKey="Nestle Kr Mling, Carolin" sort="Nestle Kr Mling, Carolin" uniqKey="Nestle Kr Mling C" first="Carolin" last="Nestle-Kr Mling">Carolin Nestle-Kr Mling</name></country><country name="États-Unis"><region name="Maryland"><name sortKey="Kammers, Kai" sort="Kammers, Kai" uniqKey="Kammers K" first="Kai" last="Kammers">Kai Kammers</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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