Whelan et
al in a NEJM publication report the
findings of a study on the effects regional nodal irradiation has on overall survival, disease-free survival, isolated locoregional
disease-free survival, and distant disease-free survival.
They 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).
A total of 1832 women were assigned
to the nodal-irradiation group or the control group (916 women in each group). 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. The rates of
disease-free survival were 82.0% in the nodal-irradiation group and 77.0% in
the control group. Patients in the nodal-irradiation group had higher rates of
grade 2 or greater acute pneumonitis and lymphedema.
They concluded that 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.
N Engl J Med 2015; 373:307-316
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