© The Author 2006. Published by Oxford University Press.
ARTICLE |
Survival Effects of Postmastectomy Adjuvant Radiation Therapy Using Biologically Equivalent Doses: A Clinical Perspective
Affiliation of authors: National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Australia
Correspondence to: Val Gebski, BA, MStat, National Health and Medical Research Council Clinical Trials Centre, Level 5, Bldg. F, 88 Mallett St., Camperdown NSW 2050, Australia (e-mail: val{at}ctc.usyd.edu.au).
Background: Postmastectomy radiation therapy reduces locoregional recurrence among women with operable breast cancer, but whether it improves survival has been controversial. We reanalyzed the results from 36 unconfounded trials (i.e., addition of radiation therapy was the sole discriminant between treatments being compared) that were identified in previous meta-analyses, which provided 38 comparisons. Methods: We used three predefined treatment categories for individual patient data: 1) a biologically equivalent dose (BED) of 40–60 Gy in 2-Gy fractions with an appropriate target volume, 2) an inadequate or excessive dose of radiation therapy, and 3) an inappropriate target volume. Effects of radiation therapy on 5-year and 10-year survival in each of the treatment categories were estimated from a cohort of 13 199 patients from the published rates or, if these were unavailable, from the published survival curves. We also used this categorization to reanalyze data from Early Breast Cancer Trialists' Collaborative Group (EBCTCG) postmastectomy studies. At 10 years, 16 (84%) of the 19 comparisons in our study coincided with those reported by the EBCTCG. All statistical tests were two-sided. Results: Twenty-five of the 38 available comparisons had used optimal and complete radiotherapy (i.e., category 1). Of these 25 comparisons, 17 had 5-year data, and these data showed that adjuvant radiation therapy was associated with a 2.9% absolute increase in survival (odds ratio [OR] of death = 0.87, 95% confidence interval [CI] = 0.79 to 0.96; P = .006). Thirteen category 1 trials had data at 10 years, and these data showed that adjuvant radiation therapy was associated with a statistically significant 6.4% absolute increase in survival (OR of death = 0.78, 95% CI = 0.70 to 0.85; P<.001). No statistically significant change in survival was observed among category 2 (OR of death = 0.91, 95% CI = 0.75 to 1.11) or 3 (OR of death = 0.97, 95% CI = 0.61 to 1.55) trials. Among the 33 EBCTCG studies, odds of local recurrence were reduced more among category 1 trials (80% lower) than among category 2 (70% lower) or 3 (64% lower) trials (Pheterogeneity<.001). Odds of all-cause death were also lower among category 1 trials (13% lower) than among category 2 (3% lower) or 3 (26% higher) trials (Pheterogeneity = .01). Conclusions: Adjuvant radiation therapy with an optimal BED and target volume was statistically significantly associated with improved survival for up to 10 years.
CiteULike 
Connotea 
Del.icio.us What's this?
Correspondence about this Article
- Re: Survival Effects of Postmastectomy Adjuvant Radiation Therapy Using Biologically Equivalent Doses: A Clinical Perspective
- Ian Kunkler, Nicola Russell, Peter Canney, Karen Venables, and John Bartlett
J Natl Cancer Inst 2006 98: 1020-1021.[Extract] [Full Text] [PDF]
- Re: Survival Effects of Postmastectomy Adjuvant Radiation Therapy Using Biologically Equivalent Doses: A Clinical Perspective
- Carl D. Atkins
J Natl Cancer Inst 2006 98: 1021.[Extract] [Full Text] [PDF]
Editorial about this Article
- Postmastectomy Radiotherapy: Quality Counts!
- Leonard R. Prosnitz and Lawrence B. Marks
J Natl Cancer Inst 2006 98: 3-4.[Extract] [Full Text] [PDF]
This article has been cited by other articles:
|
|
 |
|
  G. Werkoff, E. Lambaudie, E. Fondrinier, J. Leveque, F. Marchal, M. Uzan, E. Barranger, F. Guillemin, E. Darai, S. Uzan, et al. Prospective Multicenter Comparison of Models to Predict Four or More Involved Axillary Lymph Nodes in Patients With Breast Cancer With One to Three Metastatic Sentinel Lymph Nodes J. Clin. Oncol., December 1, 2009; 27(34): 5707 - 5712. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F.-C. Bidard, Y. M. Kirova, A. Vincent-Salomon, S. Alran, Y. de Rycke, B. Sigal-Zafrani, X. Sastre-Garau, L. Mignot, A. Fourquet, and J.-Y. Pierga Disseminated tumor cells and the risk of locoregional recurrence in nonmetastatic breast cancer Ann. Onc., November 1, 2009; 20(11): 1836 - 1841. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. J. Spillane, F. Noushi, R. A. Cooper, V. Gebski, and R. F. Uren High-resolution lymphoscintigraphy is essential for recognition of the significance of internal mammary nodes in breast cancer Ann. Onc., June 1, 2009; 20(6): 977 - 984. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Hickey, M. Peate, C.M. Saunders, and M. Friedlander Breast cancer in young women and its impact on reproductive function Hum. Reprod. Update, May 1, 2009; 15(3): 323 - 339. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. S. Russell, I. H. Kunkler, G. van Tienhoven, P. A. Canney, J. Thomas, J. Bartlett, M. J. van de Vijver, Y. Belkacemi, J. R. Yarnold, and P. J. Barrett-Lee Postmastectomy Radiotherapy: Will the Selective Use of Postmastectomy Radiotherapy Study End the Debate? J. Clin. Oncol., February 20, 2009; 27(6): 996 - 997. [Full Text] [PDF]
|
|
|
|
 |
|
 N. C Turner and A. L Jones Management of breast cancer--Part I BMJ, July 4, 2008; 337(jul04_1): a421 - a421. [Full Text]
|
|
|
|
|
|
S. H. Yang, K. H. Yang, Y. P. Li, Y. C. Zhang, X. D. He, A. L. Song, J. H. Tian, L. Jiang, Z. G. Bai, L. F. He, et al. Breast conservation therapy for stage I or stage II breast cancer: a meta-analysis of randomized controlled trials Ann. Onc., June 1, 2008; 19(6): 1039 - 1044. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. B. Marks, J. Zeng, and L. R. Prosnitz One to Three Versus Four or More Positive Nodes and Postmastectomy Radiotherapy: Time to End the Debate J. Clin. Oncol., May 1, 2008; 26(13): 2075 - 2077. [Full Text] [PDF]
|
|
|
|
|
|
B. D. Smith, B. G. Haffty, A. Hurria, D. H. Galusha, and C. P. Gross Postmastectomy Radiation and Survival in Older Women With Breast Cancer J. Clin. Oncol., October 20, 2006; 24(30): 4901 - 4907. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Shikama, M. Mitsumori, C. Yamauchi, H. Takekawa, K. Arakawa, S. Sasaki, and T. Teshima Patterns of Care Study for Postmastectomy Radiotherapy in Japan: Its Role in Monitoring the Patterns of Changes in Practice Jpn. J. Clin. Oncol., August 1, 2006; 36(8): 499 - 503. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. Kunkler, N. Russell, P. Canney, K. Venables, and J. Bartlett Re: Survival effects of postmastectomy adjuvant radiation therapy using biologically equivalent doses: a clinical perspective. J Natl Cancer Inst, July 19, 2006; 98(14): 1020 - 1021. [Full Text] [PDF]
|
|
|
|
|
|
C. D. Atkins Re: Survival effects of postmastectomy adjuvant radiation therapy using biologically equivalent doses: a clinical perspective. J Natl Cancer Inst, July 19, 2006; 98(14): 1021 - 1021. [Full Text] [PDF]
|
|
|
|
|
|
L. R. Prosnitz and L. B. Marks Postmastectomy Radiotherapy: Quality Counts! J Natl Cancer Inst, January 4, 2006; 98(1): 3 - 4. [Full Text] [PDF]
|
|