Regional Nodal Irradiation in Early-Stage Breast Cancer

被引：905

作者：

Whelan, Timothy J. ^{[1
,2
]}

Olivotto, Ivo A. ^{[3
,4
]}

Parulekar, Wendy R. ^{[5
,6
]}

Ackerman, Ida ^{[7
,8
]}

Chua, Boon H. ^{[18
]}

Nabid, Abdenour ^{[9
]}

Vallis, Katherine A. ^{[19
]}

White, Julia R. ^{[20
]}

Rousseau, Pierre ^{[10
]}

Fortin, Andre ^{[11
,12
]}

Pierce, Lori J. ^{[21
]}

Manchul, Lee ^{[13
]}

Chafe, Susan ^{[14
]}

Nolan, Maureen C. ^{[15
]}

Craighead, Peter ^{[3
]}

Bowen, Julie ^{[16
]}

McCready, David R. ^{[13
]}

Pritchard, Kathleen I. ^{[7
,8
]}

Gelmon, Karen ^{[17
]}

Murray, Yvonne ^{[5
,6
]}

Chapman, Judy-Anne W. ^{[5
,6
]}

Chen, Bingshu E. ^{[5
,6
]}

Levine, Mark N. ^{[1
,2
]}

机构：

[1] McMaster Univ, Dept Oncol, Hamilton, ON, Canada

[2] Juravinski Canc Ctr, Hamilton, ON, Canada

[3] Tom Baker Canc Clin, Calgary, AB, Canada

[4] BC Canc Agcy, Vancouver Isl Ctr, Victoria, BC, Canada

[5] Queens Univ, Kingston, ON, Canada

[6] NCIC Clin Trials Grp, Kingston, ON, Canada

[7] Univ Toronto, Toronto, ON, Canada

[8] Sunnybrook Odette Canc Ctr, Toronto, ON, Canada

[9] Fleurimont Hosp, Ctr Univ Sherbrooke, Sherbrooke, PQ, Canada

[10] Univ Montreal, Montreal, PQ, Canada

[11] Univ Laval, Quebec City, PQ, Canada

[12] Hotel Dieu Quebec, Quebec City, PQ, Canada

[13] Princess Margaret Hosp, Toronto, ON M4X 1K9, Canada

[14] Cross Canc Inst, Edmonton, AB T6G 1Z2, Canada

[15] Nova Scotia Canc Ctr, Halifax, NS, Canada

[16] Northeastern Ontario Reg Canc Ctr, Sudbury, ON, Canada

[17] BC Canc Agcy, Vancouver Ctr, Vancouver, BC, Canada

[18] Peter MacCallum Canc Ctr, Melbourne, Vic, Australia

[19] Canc Res UK, MRC, Oxford Inst Radiat Oncol, Oxford, England

[20] Ohio State Univ, Wexner Med Ctr, Columbus, OH 43210 USA

[21] Univ Michigan, Ctr Comprehens Canc, Ann Arbor, MI 48109 USA

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2015年 / 373卷 / 04期

关键词：

RANDOMIZED CLINICAL-TRIAL; INTERNAL MAMMARY; HIGH-RISK; POSTMASTECTOMY RADIOTHERAPY; POSTOPERATIVE RADIOTHERAPY; AXILLARY DISSECTION; PREMENOPAUSAL WOMEN; COOPERATIVE-GROUP; MASTECTOMY; CHEMOTHERAPY;

D O I：

10.1056/NEJMoa1415340

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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.

引用

页码：307 / 316

页数：10

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