Internal Mammary and Medial Supraclavicular Irradiation in Breast Cancer

摘要: BACKGROUND The effect of internal mammary and medial supraclavicular lymph-node irradiation (regional nodal irradiation) added to whole-breast or thoracic-wall after surgery on survival among women with early-stage breast cancer is unknown. METHODS We randomly assigned who had a centrally medially located primary tumor, irrespective axillary involvement, an externally tumor involvement undergo either in addition regional (nodal-irradiation group) alone (control group). end point was overall survival. Secondary points were the rates disease-free survival, free from distant disease, death cancer. RESULTS Between 1996 2004, total 4004 patients underwent randomization. majority (76.1%) breast-conserving surgery. After mastectomy, 73.4% both groups chest-wall irradiation. Nearly all node-positive disease (99.0%) 66.3% node-negative received adjuvant systemic treatment. At median follow-up 10.9 years, 811 died. 10 82.3% nodal-irradiation group 80.7% control (hazard ratio for irradiation, 0.87; 95% confidence interval [CI], 0.76 1.00; P = 0.06). rate 72.1% 69.1% progression death, 0.89; CI, 0.80 0.04), 78.0% versus 75.0% ratio, 0.86; 0.98; 0.02), breast-cancer mortality 12.5% 14.4% 0.82; 0.70 0.97; 0.02). Acute side effects modest. CONCLUSIONS In cancer, nodes marginal Disease-free improved, reduced. (Funded by Fonds Cancer; ClinicalTrials.gov number, NCT00002851.)