Post on 11-Jan-2016
description
History of the randomized evidence on early breast cancer overall survival:
Radiation vs no radiationafter mastectomy
L. Vakaet
2006
The effect of RT on the chance of locoregional recurrence after mastectomy
(node positive patients)
Lancet 2005
Materials and methods (1/2)• Only evidence from randomized clinical
trials (EBCTCG)
• All patients, in both arms, received mastectomy
• Only comparison is RT versus no RT
• First graph endpoint = locoregional recurrence
Materials and methods• All other graphs endpoint = Overall Survival • Overall survival = Death after breast cancer
relapse (breast cancer mortality) + Other deaths (non-breast cancer mortality)
• All evidence (the good and the bad), no selection of only the « good » results (cfr only 5 yrs of tamoxifen!)
• First studies started in the 1950’s! Randomization by envelope.
Overall SurvivalFirst RT vs no RT meta-analysis
Cuzick et al. Ca Tr Rep 1987, 3400 pts
Follow-up after 10 years (1400 pts)
Combined graph
Second RT vs no RT meta-analysis Cuzick JCO 1994; (3362 pts)
Survival with or without RT EBCTCG Lancet 2000 (5240 pts)
Survival with or without RT EBCTCG Lancet 2000 (5240 pts)
EBCTCG Oxford 2000
Jan Van de Steene
Gebski et al. 2006
Quality counts, also in RT (biologically equivalent dose)
Gebski et al. 2006
An early example of treatment of breast cancer by irradiation (1908)
Patient positioning
Isocenter lines and fieldborders
Simulation radiograph
PLUNC isodoses in breast cancer
Treatment techniques overview R&O 2002
EBCTCG Lancet 2005;(9933 pts)
EBCTCG Oxford 2006(6020 node positive pts)
Indications for radiation treatment after mastectomy
• Poorly differentiated tumors
• T3 – T4 lesions
• Node positive patients:– 1 to 3 nodes positive: OS gain of 3% at 20
years (NNT = 33)– 4 or more nodes positive: OS gain of >8% at
20 years (NNT = 12)
• No importance: age and ER status.