The EORTC 22922/10925 trial investigating regional nodal irradiation in stage I-III breast cancer: Outcomes according to locoregional and systemic therapies.

Autor: Kaidar-Person O; Breast Cancer Radiation Therapy Unit, Sheba Medical Center, Ramat Gan, Israel; The School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Dept. Radiation Oncology (Maastro), GROW-Research Institute for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, the Netherlands. Electronic address: Orit.KaidarPerson@sheba.health.gov.il., Boersma LJ; Dept. Radiation Oncology (Maastro), GROW-Research Institute for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, the Netherlands., De Brouwer P; Department of Radiation Oncology, Institute Verbeeten, Tilburg, the Netherlands., Weltens C; Department of Radiation Oncology, University Hospital Leuven, KU Leuven Faculty of Medicine, Leuven, Belgium., Kirkove C; Department of Radiation Oncology, University Hospital Saint Luc, Université Catholique de Louvain, Brussels, Belgium., Peignaux-Casasnovas K; Department of Radiation Oncology, Centre Georges François Leclerc, Dijon, France., Budach V; Department of Radiation Oncology and Radiotherapy, Comprehensive Cancer Center, Charite University Medicine, Berlin, Germany., van der Leij F; Department of Radiation Oncology, University Medical Centre Utrecht, Utrecht, the Netherlands., Peters M; Radiotherapiegroep, Deventer/Arnhem, the Netherlands., Weidner N; Department of Radiation Oncology, University Hospital, Tübingen, Germany., Rivera S; Department of Radiation Oncology, Gustave Roussy Cancer Centre, Villejuif, France., van Tienhoven G; Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands., Fourquet A; Department of Radiation Oncology, Institut Curie, Paris, France., Noel G; Department of Radiation Oncology, Centre Paul Strauss, Strasbourg, France., Valli M; Department of Radiation Oncology, Sant Anna Hospital, Como, Italy., Guckenberger M; Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland., Koiter E; Department of Radiation Oncology, Medisch Spectrum Twente, Enschede, the Netherlands., Racadot S; Department of Radiation Oncology, Centre Léon Bérard, Lyon, France., Abdah-Bortnyak R; Department of Radiation Oncology, The Joseph Fishman Oncology Center, Rambam Medical Centre, Haifa, Israel; The Technion Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel., Bartelink H; Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands., Struikmans H; Department of Radiation Oncology, Leiden University Medical Centre, Leiden, the Netherlands., Fortpied C; EORTC Headquarters, Brussels, Belgium., Poortmans PM; Department of Radiation Oncology, Institute Verbeeten, Tilburg, the Netherlands; Department of Radiation Oncology, Iridium Netwerk, Wilrijk-Antwerp, Belgium; University of Antwerp, Faculty of Medicine and Health Sciences, Wilrijk-Antwerp, Belgium.
Jazyk: angličtina
Zdroj: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology [Radiother Oncol] 2024 Dec; Vol. 201, pp. 110563. Date of Electronic Publication: 2024 Sep 26.
DOI: 10.1016/j.radonc.2024.110563
Abstrakt: The EORTC 22922/10925 trial aimed to investigate the impact on overall survival (OS) of elective internal mammary and medial supraclavicular (IM-MS) radiation therapy (RT) in breast cancer stage I-III. Surgery for the primary tumour and axillary lymph nodes, chest wall RT, boost RT after whole breast RT in breast conserving therapy (BCT), RT to operated axilla, and systemic therapy were per physician's preference. The aim of the current analysis is to assess breast cancer outcomes according to different locoregional and systemic therapy used in the trial.
Material/methods: Data with a median follow-up of 15.7 years were extracted from the trial's case report forms. Kaplan-Meier curves of disease-free and OS and cumulative incidence curves of breast cancer events were produced. An exploratory analysis of the effect of the type of locoregional and systemic therapy on breast cancer outcomes was conducted using the Cox model or the Fine & Gray model accounting for competing risks, both models being adjusted for baseline patient and disease characteristics and treatment. The significance level was set at 5 %, 2-sided.
Results: Of the 4,004 patients included, 625 (16%) did not receive any postoperative systemic therapy, 1,185 (30%) received endocrine therapy only, 994 (25%) chemotherapy only, and 1,200 (30%) both chemotherapy and endocrine therapy, without differences between the randomisation arms. Administration and type of therapy was associated with age, menopausal status, clinical T- and N-stage and ER status (p < 0.0001). Local control was better with mastectomy (with/without postmastectomy RT) as compared to BCT, but mastectomy was associated with more distant metastasis (DM) as first event. Similarly, DM as first event occurred more in the BCT group that received a boost as compared to no boost and in those who received RT to the lower axillary level. IM-MS RT reduced significantly regional recurrences and improved disease-free survival in a sensitivity stratified analysis. OS was worse with mastectomy as compared to BCT and with irradiation of the axilla but better with sentinel node dissection and adjuvant combined chemo and hormonal therapy.
Conclusion: Different components of therapy influenced the site of first event. IM-MS RT improved outcomes in different breast cancer outcomes were most probably related that the group were balanced due to the trial arms and stratification methods.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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