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.
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.
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.
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. (Funded by Fonds Cancer; ClinicalTrials.gov number, NCT00002851.).
In Regard to Vaidya et al Meattini, Icro; Boersma, Liesbeth; Livi, Lorenzo ...
International journal of radiation oncology, biology, physics,
08/2015, Letnik:
92, Številka:
5
Journal Article
Objective: Primary uterine leiomyosarcomas(ULMS) are rare,and the optimal treatment is controversial.We aimed to assess the outcome and prognostic factors in a multicenter population of women treated ...for primary ULMS.Methods: We retrospectively collected data of 110 women treated in 19 institutions of the Rare Cancer Network(RCN).Inclusion criteria consisted of a pathology report confirming the diagnosis of ULMS,aged 18–80 years,complete International Federation of Gynecology and Obstetrics(FIGO) stage information,complete information on treatment,and a minimum follow-up of 6 months.Local control(LC) and locoregional control(LRC),overall survival(OS) and disease-free survival(DFS) rates were computed using the Kaplan-Meier method.Univariate analysis was implemented using the log rank test,and multivariate analysis using the Cox model.Results: All patients underwent surgery.Seventy-five patients(68%) received adjuvant radiotherapy(RT),including brachytherapy in 18(16%).Seventeen patients(15%) received adjuvant chemotherapy.Median follow-up was 58(range,6–240) months.Five-year OS and DFS rates were 50% and 34%,and LC and LRC rates were 88%and 72%,respectively.On multivariate analysis,independent favorable prognostic factors were younger age,FIGO stage I,small tumor size,previous uterine disease,and no vascular invasion for OS and DFS.FIGO stage was the only favorable factor influencing LRC.Adjuvant local or systemic treatments did not improve the outcomes.Eight patients treated with RT presented a grade 3 acute toxicity,and only one patient with grade 3 late toxicity.Conclusions: In this large population of primary ULMS patients,we found good results in terms of LC and LRC.Nevertheless,OS remains poor,mainly due to the occurrence of distant metastases.An early diagnosis seemed to improve the prognosis of the patients.Adjuvant local or systemic treatments,or more aggressive surgicalprocedures such as the Wertheim procedure,did not seem to impact the outcome.
10-year results from several studies showed improved disease-free survival and distant metastasis-free survival, reduced breast cancer-related mortality, and variable effects on overall survival with ...the addition of partial or comprehensive regional lymph node irradiation after surgery in patients with breast cancer. We present the scheduled 15-year analysis of the European Organisation for Research and Treatment of Cancer (EORTC) 22922/10925 trial, which aims to investigate the impact on overall survival of elective internal mammary and medial supraclavicular (IM-MS) irradiation.
EORTC 22922/10925, a randomised, phase 3 trial done across 46 radiation oncology departments from 13 countries, included women up to 75 years of age with unilateral, histologically confirmed, stage I–III breast adenocarcinoma with involved axillary nodes or a central or medially located primary tumour. Surgery consisted of mastectomy or breast-conserving surgery and axillary staging. Patients were randomly assigned (1:1) centrally using minimisation to receive IM-MS irradiation at 50 Gy in 25 fractions (IM-MS irradiation group) or no IM-MS irradiation (control group). Stratification was done for institution, menopausal status, site of the primary tumour within the breast, type of breast and axillary surgery, and pathological T and N stage. Patients and investigators were not masked to treatment allocation. The primary endpoint was overall survival analysed according to the intention-to-treat principle. Secondary endpoints were disease-free survival, distant metastasis-free survival, breast cancer mortality, any breast cancer recurrence, and cause of death. Follow-up is ongoing for 20 years after randomisation. This study is registered with ClinicalTrials.gov, NCT00002851.
Between Aug 5, 1996, and Jan 13, 2004, we enrolled 4004 patients, of whom 2002 were randomly assigned to the IM-MS irradiation group and 2002 to the no IM-MS irradiation group. At a median follow-up of 15·7 years (IQR 14·0–17·6), 554 (27·7%) patients in the IM-MS irradiation group and 569 (28·4%) patients in the control group had died. Overall survival was 73·1% (95% CI 71·0–75·2) in the IM-MS irradiation group and 70·9% (68·6–72·9) in the control group (HR 0·95 95% CI 0·84–1·06, p=0·36). Any breast cancer recurrence (24·5% 95% CI 22·5–26·6 vs 27·1% 25·1–29·2; HR 0·87 95% CI 0·77–0·98, p=0·024) and breast cancer mortality (16·0% 14·3–17·7 vs 19·8% 18·0–21·7; 0·81 0·70–0·94, p=0·0055) were lower in the IM-MS irradiation group than in the control group. No significant differences in the IM-MS irradiation group versus the control group were seen for disease-free survival (60·8% 95% CI 58·4–63·2 vs 59·9% 57·5–62·2; HR 0·93 95% CI 0·84–1·03, p=0·18), or distant metastasis-free survival (70·0% 67·7–72·2 vs 68·2% 65·9–70·3; 0·93 0·83–1·04, p=0·18). Causes of death between groups were similar.
The 15-year results show a significant reduction of breast cancer mortality and any breast cancer recurrence by IM-MS irradiation in stage I–III breast cancer. However, this is not converted to improved overall survival.
Ligue Nationale contre le Cancer and KWF Kankerbestrijding.
Abstract Background and purpose Delineation of clinical target volumes (CTVs) is a weak link in radiation therapy (RT), and large inter-observer variation is seen in breast cancer patients. Several ...guidelines have been proposed, but most result in larger CTVs than based on conventional simulator-based RT. The aim was to develop a delineation guideline obtained by consensus between a broad European group of radiation oncologists. Material and methods During ESTRO teaching courses on breast cancer, teachers sought consensus on delineation of CTV through dialogue based on cases. One teacher delineated CTV on CT scans of 2 patients, followed by discussion and adaptation of the delineation. The consensus established between teachers was sent to other teams working in the same field, both locally and on a national level, for their input. This was followed by developing a broad consensus based on discussions. Results Borders of the CTV encompassing a 5 mm margin around the large veins, running through the regional lymph node levels were agreed, and for the breast/thoracic wall other vessels were pointed out to guide delineation, with comments on margins for patients with advanced breast cancer. Conclusion The ESTRO consensus on CTV for elective RT of breast cancer, endorsed by a broad base of the radiation oncology community, is presented to improve consistency.
•40 dose plans from the Skagen Trial 1 collected from Denmark, Belgium and Norway.•Atlas-based automated segmentation of each CT scan was obtained using MIM Maestro™.•DSC and difference in volume ...with manual segmentation were collected.•HI, V95 and V90% measured on the two different segmentations were compared.•Inter-observer variability was low and dose parameters were comparable.
The effect of Atlas-based automated segmentation (ABAS) on dose volume histogram (DVH) parameters compared to manual segmentation (MS) in loco-regional radiotherapy (RT) of early breast cancer was investigated in patients included in the Skagen Trial 1.
This analysis supports implementation of ABAS in clinical practice and multi-institutional trials.
Abstract Objective A national project to improve the quality of breast radiation therapy was started, named PROCAB (PROject on CAncer of the Breast). One of the objectives was to reach a national ...consensus guideline for the delineation of the regional lymph node areas in breast radiation therapy. Methods The realization of the new guidelines was a step by step process that started with multiple expert meetings where the existing guidelines were analyzed and the delineations of the lymph node regions were performed together with a surgeon, specialized in the anatomy of the drainage of the breast. Results The delineation guidelines are vessel-based. Since the occurrence of pathological lymph nodes is typically around the veins, the cranial and caudal borders of all different nodal regions are based on a 5 mm margin around the veins, except for the parasternal lymph node area. Compared to the existing guidelines there are some major changes. Conclusion With this project a national as well as a European (ESTRO) consensus guideline for the delineation of the regional lymph node areas in breast RT is reached. The new delineation atlas is vessel-based and no longer field-based.
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