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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Regional Nodal Irradiation in Early-Stage Breast Cancer</title><author><name sortKey="Whelan, Timothy J" sort="Whelan, Timothy J" uniqKey="Whelan T" first="Timothy J." last="Whelan">Timothy J. 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></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26200977</idno><idno type="pmc">4556358</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4556358</idno><idno type="RBID">PMC:4556358</idno><idno type="doi">10.1056/NEJMoa1415340</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">003289</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">003289</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Regional Nodal Irradiation in Early-Stage Breast Cancer</title><author><name sortKey="Whelan, Timothy J" sort="Whelan, Timothy J" uniqKey="Whelan T" first="Timothy J." last="Whelan">Timothy J. 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></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><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">0255562</journal-id><journal-id journal-id-type="pubmed-jr-id">5985</journal-id><journal-id journal-id-type="nlm-ta">N Engl J Med</journal-id><journal-id journal-id-type="iso-abbrev">N. Engl. J. Med.</journal-id><journal-title-group><journal-title>The New England journal of medicine</journal-title></journal-title-group><issn pub-type="ppub">0028-4793</issn><issn pub-type="epub">1533-4406</issn></journal-meta><article-meta><article-id pub-id-type="pmid">26200977</article-id><article-id pub-id-type="pmc">4556358</article-id><article-id pub-id-type="doi">10.1056/NEJMoa1415340</article-id><article-id pub-id-type="manuscript">NIHMS711757</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Regional Nodal Irradiation in Early-Stage Breast Cancer</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Whelan</surname><given-names>Timothy J.</given-names></name><degrees>B.M., B.Ch.</degrees></contrib><contrib contrib-type="author"><name><surname>Olivotto</surname><given-names>Ivo A.</given-names></name><degrees>M.D.</degrees></contrib><contrib contrib-type="author"><name><surname>Parulekar</surname><given-names>Wendy R.</given-names></name><degrees>M.D.</degrees></contrib><contrib contrib-type="author"><name><surname>Ackerman</surname><given-names>Ida</given-names></name><degrees>M.D.</degrees></contrib><contrib contrib-type="author"><name><surname>Chua</surname><given-names>Boon H.</given-names></name><degrees>M.B., B.S., Ph.D.</degrees></contrib><contrib contrib-type="author"><name><surname>Nabid</surname><given-names>Abdenour</given-names></name><degrees>M.D.</degrees></contrib><contrib contrib-type="author"><name><surname>Vallis</surname><given-names>Katherine A.</given-names></name><degrees>M.B., B.S., Ph.D.</degrees></contrib><contrib contrib-type="author"><name><surname>White</surname><given-names>Julia R.</given-names></name><degrees>M.D.</degrees></contrib><contrib contrib-type="author"><name><surname>Rousseau</surname><given-names>Pierre</given-names></name><degrees>M.D.</degrees></contrib><contrib contrib-type="author"><name><surname>Fortin</surname><given-names>Andre</given-names></name><degrees>M.D.</degrees></contrib><contrib contrib-type="author"><name><surname>Pierce</surname><given-names>Lori J.</given-names></name><degrees>M.D.</degrees></contrib><contrib contrib-type="author"><name><surname>Manchul</surname><given-names>Lee</given-names></name><degrees>M.D.</degrees></contrib><contrib contrib-type="author"><name><surname>Chafe</surname><given-names>Susan</given-names></name><degrees>M.D.</degrees></contrib><contrib contrib-type="author"><name><surname>Nolan</surname><given-names>Maureen C.</given-names></name><degrees>M.D.</degrees></contrib><contrib contrib-type="author"><name><surname>Craighead</surname><given-names>Peter</given-names></name><degrees>M.D.</degrees></contrib><contrib contrib-type="author"><name><surname>Bowen</surname><given-names>Julie</given-names></name><degrees>M.D.</degrees></contrib><contrib contrib-type="author"><name><surname>McCready</surname><given-names>David R.</given-names></name><degrees>M.D.</degrees></contrib><contrib contrib-type="author"><name><surname>Pritchard</surname><given-names>Kathleen I.</given-names></name><degrees>M.D.</degrees></contrib><contrib contrib-type="author"><name><surname>Gelmon</surname><given-names>Karen</given-names></name><degrees>M.D.</degrees></contrib><contrib contrib-type="author"><name><surname>Murray</surname><given-names>Yvonne</given-names></name><degrees>B.Sc.</degrees></contrib><contrib contrib-type="author"><name><surname>Chapman</surname><given-names>Judy-Anne W.</given-names></name><degrees>Ph.D.</degrees></contrib><contrib contrib-type="author"><name><surname>Chen</surname><given-names>Bingshu E.</given-names></name><degrees>Ph.D.</degrees></contrib><contrib contrib-type="author"><name><surname>Levine</surname><given-names>Mark N.</given-names></name><degrees>M.D.</degrees></contrib><contrib contrib-type="author"><collab>the MA.20 Study Investigators</collab><xref ref-type="author-notes" rid="FN1">*</xref></contrib><aff id="A1">Department of Oncology, McMaster University, and Juravinski Cancer Centre, Hamilton, ON (T.J.W., M.N.L.), Tom Baker Cancer Centre, Calgary, AB (I.A.O., P.C.), BC Cancer Agency–Vancouver Island Centre, Victoria, BC (I.A.O.), Queen's University and NCIC Clinical Trials Group, Kingston, ON (W.R.P., Y.M., J.-A.W.C., B.E.C.), University of Toronto and Sunnybrook Odette Cancer Centre, Toronto (I.A., K.I.P.), Centre Universitaire de Sherbrooke at Fleurimont Hospital, Sherbrooke, QC (A.N.), Université de Montréal, Montreal (P.R.), Laval University and L'Hôtel-Dieu de Québec, Quebec, QC (A.F.), Princess Margaret Hospital, Toronto (L.M., D.R.M.), Cross Cancer Institute, Edmonton, AB (S.C.), Nova Scotia Cancer Centre, Halifax (M.C.N), Northeastern Ontario Regional Cancer Centre, Sudbury (J.B.), and BC Cancer Agency–Vancouver Centre, Vancouver, BC (K.G.) — all in Canada; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia (B.H.C.); Cancer Research UK–Medical Research Council Oxford Institute for Radiation Oncology, Oxford, United Kingdom (K.A.V.); Ohio State University Wexner Medical Center, Columbus (J.R.W.); and the University of Michigan Comprehensive Cancer Center, Ann Arbor (L.J.P.).</aff></contrib-group><author-notes><fn id="FN1"><label>*</label><p id="P1">A list of the MA.20 study investigators is provided in the <xref ref-type="supplementary-material" rid="SD1">Supplementary Appendix</xref>, available at <ext-link ext-link-type="uri" xlink:href="http://NEJM.org">NEJM.org</ext-link>.</p></fn><corresp id="CR1">Address reprint requests to Dr. Whelan at the Juravinski Cancer Centre at Hamilton Health Sciences, 699 Concession St., Rm. 4-204, Hamilton, ON L8V 5C2, Canada, or at <email>twhelan@hhsc.ca</email>.</corresp></author-notes><pub-date pub-type="nihms-submitted"><day>16</day><month>8</month><year>2015</year></pub-date><pub-date pub-type="ppub"><day>23</day><month>7</month><year>2015</year></pub-date><pub-date pub-type="pmc-release"><day>23</day><month>1</month><year>2016</year></pub-date><volume>373</volume><issue>4</issue><fpage>307</fpage><lpage>316</lpage><pmc-comment>elocation-id from pubmed: 10.1056/NEJMoa1415340</pmc-comment>
<abstract><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></abstract></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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