Internal Mammary and Medial Supraclavicular Irradiation in Breast Cancer

被引：805

作者：

Poortmans, P. M. ^{[1
,2
]}

Collette, S. ^{[8
]}

Kirkove, C. ^{[9
]}

Van Limbergen, E. ^{[10
]}

Budach, V. ^{[11
]}

Struikmans, H. ^{[3
,4
]}

Collette, L. ^{[8
]}

Fourquet, A. ^{[13
]}

Maingon, P. ^{[14
]}

Valli, M. ^{[17
,19
]}

De Winter, K. ^{[2
]}

Marnitz, S. ^{[11
]}

Barillot, I. ^{[14
,15
]}

Scandolaro, L. ^{[19
]}

Vonk, E. ^{[5
]}

Rodenhuis, C. ^{[4
]}

Marsiglia, H. ^{[16
]}

Weidner, N. ^{[12
]}

van Tienhoven, G. ^{[6
]}

Glanzmann, C. ^{[18
]}

Kuten, A. ^{[20
]}

Arriagada, R. ^{[21
]}

Bartelink, H. ^{[7
]}

van den Bogaert, W. ^{[10
]}

机构：

[1] Radboud Univ Nijmegen, Med Ctr, Dept Radiat Oncol, NL-6500 HB Nijmegen, Netherlands

[2] Inst Verbeeten, Dept Radiat Oncol, Tilburg, Netherlands

[3] Med Ctr Haaglanden, Dept Radiat Oncol, The Hague, Netherlands

[4] Univ Med Ctr Utrecht, Dept Radiat Oncol, Utrecht, Netherlands

[5] Inst Stedendriehoek & Omstreken, Inst Radiat Oncol Radiotherapeut, Dept Radiat Oncol, Deventer, Netherlands

[6] Univ Amsterdam, Acad Med Ctr, Dept Radiat Oncol, NL-1105 AZ Amsterdam, Netherlands

[7] Antoni van Leeuwenhoek Hosp, Netherlands Canc Inst, Dept Radiat Oncol, Amsterdam, Netherlands

[8] Catholic Univ Louvain, European Org Res & Treatment Canc EORTC Headquart, B-1200 Brussels, Belgium

[9] Catholic Univ Louvain, St Luc Univ Hosp, Dept Radiat Oncol, B-1200 Brussels, Belgium

[10] Univ Hosp Gasthuisberg, Dept Radiat Oncol, Leuven, Belgium

[11] Charite, Dept Radiat Oncol, D-13353 Berlin, Germany

[12] Univ Hosp, Dept Radiat Oncol, Tubingen, Germany

[13] Inst Curie, Dept Radiat Oncol, Paris, France

[14] Ctr Georges Francois Leclerc, Dept Radiat Oncol, Dijon, France

[15] Univ Tours, Dept Radiat Oncol, Tours, France

[16] Gustave Roussy Canc Ctr, Dept Radiat Oncol, Villejuif, France

[17] Osped Reg Bellinzona & Valli, Dept Radiat Oncol, Bellinzona, Switzerland

[18] Univ Zurich Hosp, Dept Radiat Oncol, Zurich, Switzerland

[19] St Anna Hosp, Dept Radiat Oncol, Como, Italy

[20] Rambam Med Ctr, Dept Radiat Oncol, Haifa, Israel

[21] Grp Oncol Cooperat Chileno Invest, Santiago, Chile

来源：

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

关键词：

LYMPH-NODE CHAIN; QUALITY-ASSURANCE; CARDIAC TOXICITY; HIGH-RISK; POSTOPERATIVE RADIOTHERAPY; PREMENOPAUSAL WOMEN; RADIATION-THERAPY; RANDOMIZED-TRIAL; STAGE-I; MORTALITY;

D O I：

10.1056/NEJMoa1415369

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND The effect of internal mammary and medial supraclavicular lymph-node irradiation (regional nodal irradiation) added to whole-breast or thoracic-wall irradiation after surgery on survival among women with early-stage breast cancer is unknown. METHODS We randomly assigned women who had a centrally or medially located primary tumor, irrespective of axillary involvement, or an externally located tumor with axillary involvement to undergo either whole-breast or thoracic-wall irradiation in addition to regional nodal irradiation (nodal-irradiation group) or whole-breast or thoracic-wall irradiation alone (control group). The primary end point was overall survival. Secondary end points were the rates of disease-free survival, survival free from distant disease, and death from breast cancer. RESULTS Between 1996 and 2004, a total of 4004 patients underwent randomization. The majority of patients (76.1%) underwent breast-conserving surgery. After mastectomy, 73.4% of the patients in both groups underwent chest-wall irradiation. Nearly all patients with node-positive disease (99.0%) and 66.3% of patients with node-negative disease received adjuvant systemic treatment. At a median follow-up of 10.9 years, 811 patients had died. At 10 years, overall survival was 82.3% in the nodal-irradiation group and 80.7% in the control group (hazard ratio for death with nodal irradiation, 0.87; 95% confidence interval [CI], 0.76 to 1.00; P = 0.06). The rate of disease-free survival was 72.1% in the nodal-irradiation group and 69.1% in the control group (hazard ratio for disease progression or death, 0.89; 95% CI, 0.80 to 1.00; P = 0.04), the rate of distant disease-free survival was 78.0% versus 75.0% (hazard ratio, 0.86; 95% CI, 0.76 to 0.98; P = 0.02), and breast-cancer mortality was 12.5% versus 14.4% (hazard ratio, 0.82; 95% CI, 0.70 to 0.97; P = 0.02). Acute side effects of regional nodal irradiation were modest. CONCLUSIONS In patients with early-stage breast cancer, irradiation of the regional nodes had a marginal effect on overall survival. Disease-free survival and distant disease-free survival were improved, and breast-cancer mortality was reduced.

引用

页码：317 / 327

页数：11

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