DBCG-IMN: A Population-Based Cohort Study on the Effect of Internal Mammary Node Irradiation in Early Node-Positive Breast Cancer.

Autor:	Thorsen LB; Lise Bech Jellesmark Thorsen, Birgitte Vrou Offersen, Marie Overgaard, and Jens Overgaard, Aarhus University Hospital, Aarhus; Hella Danø, Herlev Hospital, Herlev; Martin Berg, Vejle Hospital, Vejle; Ingelise Jensen, Aalborg University Hospital, Aalborg; Anders Navrsted Pedersen, Rigshospitalet, Copenhagen; Sune Jürg Zimmermann, Odense University Hospital, Odense, Denmark; and Hans-Jürgen Brodersen, St Franziskus-Hospital, Flensburg, Germany. liseb@oncology.au.dk., Offersen BV; Lise Bech Jellesmark Thorsen, Birgitte Vrou Offersen, Marie Overgaard, and Jens Overgaard, Aarhus University Hospital, Aarhus; Hella Danø, Herlev Hospital, Herlev; Martin Berg, Vejle Hospital, Vejle; Ingelise Jensen, Aalborg University Hospital, Aalborg; Anders Navrsted Pedersen, Rigshospitalet, Copenhagen; Sune Jürg Zimmermann, Odense University Hospital, Odense, Denmark; and Hans-Jürgen Brodersen, St Franziskus-Hospital, Flensburg, Germany., Danø H; Lise Bech Jellesmark Thorsen, Birgitte Vrou Offersen, Marie Overgaard, and Jens Overgaard, Aarhus University Hospital, Aarhus; Hella Danø, Herlev Hospital, Herlev; Martin Berg, Vejle Hospital, Vejle; Ingelise Jensen, Aalborg University Hospital, Aalborg; Anders Navrsted Pedersen, Rigshospitalet, Copenhagen; Sune Jürg Zimmermann, Odense University Hospital, Odense, Denmark; and Hans-Jürgen Brodersen, St Franziskus-Hospital, Flensburg, Germany., Berg M; Lise Bech Jellesmark Thorsen, Birgitte Vrou Offersen, Marie Overgaard, and Jens Overgaard, Aarhus University Hospital, Aarhus; Hella Danø, Herlev Hospital, Herlev; Martin Berg, Vejle Hospital, Vejle; Ingelise Jensen, Aalborg University Hospital, Aalborg; Anders Navrsted Pedersen, Rigshospitalet, Copenhagen; Sune Jürg Zimmermann, Odense University Hospital, Odense, Denmark; and Hans-Jürgen Brodersen, St Franziskus-Hospital, Flensburg, Germany., Jensen I; Lise Bech Jellesmark Thorsen, Birgitte Vrou Offersen, Marie Overgaard, and Jens Overgaard, Aarhus University Hospital, Aarhus; Hella Danø, Herlev Hospital, Herlev; Martin Berg, Vejle Hospital, Vejle; Ingelise Jensen, Aalborg University Hospital, Aalborg; Anders Navrsted Pedersen, Rigshospitalet, Copenhagen; Sune Jürg Zimmermann, Odense University Hospital, Odense, Denmark; and Hans-Jürgen Brodersen, St Franziskus-Hospital, Flensburg, Germany., Pedersen AN; Lise Bech Jellesmark Thorsen, Birgitte Vrou Offersen, Marie Overgaard, and Jens Overgaard, Aarhus University Hospital, Aarhus; Hella Danø, Herlev Hospital, Herlev; Martin Berg, Vejle Hospital, Vejle; Ingelise Jensen, Aalborg University Hospital, Aalborg; Anders Navrsted Pedersen, Rigshospitalet, Copenhagen; Sune Jürg Zimmermann, Odense University Hospital, Odense, Denmark; and Hans-Jürgen Brodersen, St Franziskus-Hospital, Flensburg, Germany., Zimmermann SJ; Lise Bech Jellesmark Thorsen, Birgitte Vrou Offersen, Marie Overgaard, and Jens Overgaard, Aarhus University Hospital, Aarhus; Hella Danø, Herlev Hospital, Herlev; Martin Berg, Vejle Hospital, Vejle; Ingelise Jensen, Aalborg University Hospital, Aalborg; Anders Navrsted Pedersen, Rigshospitalet, Copenhagen; Sune Jürg Zimmermann, Odense University Hospital, Odense, Denmark; and Hans-Jürgen Brodersen, St Franziskus-Hospital, Flensburg, Germany., Brodersen HJ; Lise Bech Jellesmark Thorsen, Birgitte Vrou Offersen, Marie Overgaard, and Jens Overgaard, Aarhus University Hospital, Aarhus; Hella Danø, Herlev Hospital, Herlev; Martin Berg, Vejle Hospital, Vejle; Ingelise Jensen, Aalborg University Hospital, Aalborg; Anders Navrsted Pedersen, Rigshospitalet, Copenhagen; Sune Jürg Zimmermann, Odense University Hospital, Odense, Denmark; and Hans-Jürgen Brodersen, St Franziskus-Hospital, Flensburg, Germany., Overgaard M; Lise Bech Jellesmark Thorsen, Birgitte Vrou Offersen, Marie Overgaard, and Jens Overgaard, Aarhus University Hospital, Aarhus; Hella Danø, Herlev Hospital, Herlev; Martin Berg, Vejle Hospital, Vejle; Ingelise Jensen, Aalborg University Hospital, Aalborg; Anders Navrsted Pedersen, Rigshospitalet, Copenhagen; Sune Jürg Zimmermann, Odense University Hospital, Odense, Denmark; and Hans-Jürgen Brodersen, St Franziskus-Hospital, Flensburg, Germany., Overgaard J; Lise Bech Jellesmark Thorsen, Birgitte Vrou Offersen, Marie Overgaard, and Jens Overgaard, Aarhus University Hospital, Aarhus; Hella Danø, Herlev Hospital, Herlev; Martin Berg, Vejle Hospital, Vejle; Ingelise Jensen, Aalborg University Hospital, Aalborg; Anders Navrsted Pedersen, Rigshospitalet, Copenhagen; Sune Jürg Zimmermann, Odense University Hospital, Odense, Denmark; and Hans-Jürgen Brodersen, St Franziskus-Hospital, Flensburg, Germany.
Jazyk:	angličtina
Zdroj:	Journal of clinical oncology : official journal of the American Society of Clinical Oncology [J Clin Oncol] 2016 Feb 01; Vol. 34 (4), pp. 314-20. Date of Electronic Publication: 2015 Nov 23.
DOI:	10.1200/JCO.2015.63.6456
Abstrakt:	Purpose: It is unknown whether irradiation of the internal mammary lymph nodes improves survival in patients with early-stage breast cancer. A possible survival benefit might be offset by radiation-induced heart disease. We assessed the effect of internal mammary node irradiation (IMNI) in patients with early-stage node-positive breast cancer. Patients and Methods: In this nationwide, prospective population-based cohort study, we included patients who underwent operation for unilateral early-stage node-positive breast cancer. Patients with right-sided disease were allocated to IMNI, whereas patients with left-sided disease were allocated to no IMNI because of the risk of radiation-induced heart disease. The primary end point was overall survival. Secondary end points were breast cancer mortality and distant recurrence. Analyses were by intention to treat. Results: A total of 3,089 patients were included. Of these, 1,492 patients were allocated to IMNI, whereas 1,597 patients were allocated to no IMNI. With a median of 8.9 years of follow-up time, the 8-year overall survival rates were 75.9% with IMNI versus 72.2% without IMNI. The adjusted hazard ratio (HR) for death was 0.82 (95% CI, 0.72 to 0.94; P = .005). Breast cancer mortality was 20.9% with IMNI versus 23.4% without IMNI (adjusted HR, 0.85; 95% CI, 0.73 to 0.98; P = .03). The risk of distant recurrence at 8 years was 27.4% with IMNI versus 29.7% without IMNI (adjusted HR, 0.89; 95% CI, 0.78 to 1.01; P = .07). The effect of IMNI was more pronounced in patients at high risk of internal mammary node metastasis. Equal numbers in each group died of ischemic heart disease. Conclusion: In this naturally allocated, population-based cohort study, IMNI increased overall survival in patients with early-stage node-positive breast cancer. (© 2015 by American Society of Clinical Oncology.)
Databáze:	MEDLINE
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