Twenty‐year results of the randomized European Organization for Research and Treatment of Cancer trial 22922/10925 evaluating internal mammary chain and medial supraclavicular lymph node irradiation in stage I–III breast cancer
Abstract
Abstract European Organization for Research and Treatment of Cancer trial EORTC 22922/10925 evaluated internal mammary and medial supraclavicular (IM‐MS) lymph node irradiation (IM‐MS‐RT) in patients with stage I–III breast cancer. Eligible patients had involved axillary nodes and/or centrally/medially located tumors regardless of nodal involvement. The primary end point was overall survival, secondary end points were disease‐free survival, distant metastases‐free survival, breast cancer mortality, and any breast recurrence. Between 1996 and 2004, 4004 patients were randomized. The median patient age was 54 years. At a median follow‐up of 22.2 years, 1550 (38.7%) patients died, of whom 796 (51.4%) died from breast cancer. At 20 years, the overall survival rate was 61.8% in the control group versus 61.0% in the IM‐MS‐RT group (hazard ratio [HR], 1.00; p = .967); the disease‐free survival rate was 49.0% versus 48.2%, respectively (HR, 0.97; p = .515); and the distant metastases‐free survival rate was 59.8% versus 58.9%, respectively (HR, 0.97; p = .578). The breast cancer mortality rate was 22.4% in the control group and 18.6% in the IM‐MS‐RT group (HR, 0.82; p = .006), whereas the rate of deaths not from breast cancer or from unknown causes was 15.8% versus 20.4%, respectively (HR, 1.26; p = .002). Lung fibrosis, cardiac fibrosis, and cardiac diseases were more frequent after IM‐MS‐RT versus no IM‐MS‐RT (6.3% vs. 3.2%, 2.7% vs. 1.7%. and 15.2% vs. 11.7%, respectively); and the rates of severe cardiac and lung morbidities (scores of 3 or 4) were 1.9% versus 1.7% and 0.3% versus 0.0%, respectively. Breast cancer mortality at 20 years was statistically significantly lower after IM‐MS‐RT, but deaths not from breast cancer increased after 15 years, resulting in no long‐term benefit of IM‐MS‐RT on overall survival. Therefore, the authors strongly call for very long‐term follow‐up of treatments for prognostically favorable cancers such as breast cancer.
Article Details
Authors (24)
Orit Kaidar‐Person
Oncology Institute Sheba Medical Center Ramat Gan Israel
Caroline G. Weltens
Department of Radiation Oncology University Hospitals Leuven Leuven Belgium
Catherine Fortpied
European Organization for Research and Treatment of Cancer Brussels Belgium
Luc J. E. E. Scheijmans
Department of Radiation Oncology Institute Verbeeten Tilburg Netherlands
Carine Y. Kirkove
Department of Radiation Oncology University Hospital Saint Luc Université Catholique de Louvain Brussels Belgium
Volker Budach
Department of Radiation Oncology Comprehensive Cancer Center Charite–University Medicine Berlin Corporate Member of Free University of Berlin and Humboldt University of Berlin BE Berlin Germany
Karine Peignaux‐Casasnovas
Department of Radiation Oncology Centre Georges François Leclerc Dijon France
Mariacarla Valli
Department of Radiation Oncology Sant Anna Hospital Como Italy
Max Peters
Department of Radiation Oncology Radiotherapiegroep Deventer/Arnhem Netherlands
Femke van der Leij
Department of Radiation Oncology University Medical Centre Utrecht Utrecht Netherlands
Sofia Rivera
Department of Radiation Oncology Gustave Roussy Cancer Centre Villejuif France
Nicola Weidner
Department of Radiation Oncology University Hospital Tübingen Germany
Desirée H. J. G. van den Bongard
Department of Radiation Oncology Cancer Center Amsterdam Amsterdam University Medical Center University of Amsterdam Amsterdam Netherlands
Claudia Linsenmeier
Department of Radiation Oncology University Hospital Zürich University of Zürich Zürich Switzerland
Roxolyana Abdah‐Bortnyak
Department of Radiation Oncology The Joseph Fishman Oncology Center Rambam Health Care Campus Haifa Israel
Shaymaa Hosni
Nottingham University Hospitals National Health Service Trust Nottingham UK
Eveline Koiter
Department of Radiation Oncology Medisch Spectrum Twente Enschede Netherlands
Antoine M. Engelen
Department of Radiation Oncology Institute Verbeeten Tilburg Netherlands
Adinda Baten
Department of Radiation Oncology University Hospitals Leuven Leuven Belgium
Lydia Champezou
European Organization for Research and Treatment of Cancer Brussels Belgium
Alain Fourquet
Department of Radiation Oncology Institut Curie Paris France
Harry G. M. M. Bartelink
Department of Radiation Oncology Netherlands Cancer Institute Amsterdam Netherlands
Henk Struikmans
Department of Radiation Oncology Haaglanden Medical Center the Hague Leidschendam Netherlands
Philip M. P. Poortmans
Department of Radiation Oncology Iridium Netwerk Wilrijk‐Antwerp Belgium