© 2005 Oxford University Press
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Locoregional Radiation Therapy in Patients With High-Risk Breast Cancer Receiving Adjuvant Chemotherapy: 20-Year Results of the British Columbia Randomized Trial
Affiliations of authors: McGill University Health Center, Montreal, PQ, Canada (JR); British Columbia Cancer Agency Systemic Therapy (JR, MAK, CMLC, KG, RD), Radiation Therapy (SMJ, LW, MM), and Population and Preventive Oncology (JJS, NP, NL, AJC) Programs of the British Columbia Cancer Agency, Vancouver and Victoria (IAO, KSW), BC, Canada
Correspondence to: Joseph Ragaz, MD, FRCPC, McGill University Health Center, Royal Victoria Hospital, 687 Pine Ave., Montreal, PQ, Canada H3A 1A1 (e-mail: joseph.ragaz{at}mcgill.ca)
Background: The British Columbia randomized radiation trial was designed to determine the survival impact of locoregional radiation therapy in premenopausal patients with lymph node–positive breast cancer treated by modified radical mastectomy and adjuvant chemotherapy. Three hundred eighteen patients were assigned to receive no further therapy or radiation therapy (37.5 Gy in 16 fractions). Previous analysis at the 15-year follow-up showed that radiation therapy was associated with a statistically significant improvement in breast cancer survival but that improvement in overall survival was of only borderline statistical significance. We report the analysis of data from the 20-year follow-up. Methods: Survival was analyzed by the Kaplan–Meier method. Relative risk estimates were calculated by the Wald test from the proportional hazards regression model. All statistical tests were two-sided. Results: At the 20 year follow up (median follow up for live patients: 249 months) chemotherapy and radiation therapy, compared with chemotherapy alone, were associated with a statistically significant improvement in all end points analyzed, including survival free of isolated locoregional recurrences (74% versus 90%, respectively; relative risk [RR] = 0.36, 95% confidence interval [CI] = 0.18 to 0.71; P = .002), systemic relapse–free survival (31% versus 48%; RR = 0.66, 95% CI = 0.49 to 0.88; P = .004), breast cancer-free survival (48% versus 30%; RR = 0.63, 95% CI = 0.47 to 0.83; P = .001), event-free survival (35% versus 25%; RR = 0.70, 95% CI = 0.54 to 0.92; P = .009), breast cancer-specific survival (53% versus 38%; RR = 0.67, 95% CI = 0.49 to 0.90; P = .008), and, in contrast to the 15-year follow-up results, overall survival (47% versus 37%; RR = 0.73, 95% CI = 0.55 to 0.98; P = .03). Long-term toxicities, including cardiac deaths (1.8% versus 0.6%), were minimal for both arms. Conclusion: For patients with high-risk breast cancer treated with modified radical mastectomy, treatment with radiation therapy (schedule of 16 fractions) and adjuvant chemotherapy leads to better survival outcomes than chemotherapy alone, and it is well tolerated, with acceptable long-term toxicity.
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Correspondence about this Article
- Re: Locoregional Radiation Therapy in Patients With High-Risk Breast Cancer Receiving Adjuvant Chemotherapy: 20-Year Results of the British Columbia Randomized Trial
- Ian Kunkler
J Natl Cancer Inst 2005 97: 1162-1163.[Extract] [Full Text] [PDF]
Editorial about this Article
- More Evidence That Locoregional Radiation Therapy Improves Survival: What Should We Do?
- Timothy Whelan and Mark Levine
J Natl Cancer Inst 2005 97: 82-84.[Extract] [Full Text] [PDF]
Related Memo to the Media
- Press Release: Adding Radiation Therapy to Chemotherapy Improves Survival in Patients With High-Risk Breast Cancer
- Sarah L. Zielinski
J Natl Cancer Inst 2005 97: 81.[Extract] [Full Text]
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