Does Locoregional Radiation Therapy Improve Survival in Breast Cancer? A Meta-Analysis

2000 ◽  
Vol 18 (6) ◽  
pp. 1220-1229 ◽  
Author(s):  
Timothy J. Whelan ◽  
Jim Julian ◽  
Jim Wright ◽  
Alejandro R. Jadad ◽  
Mark L. Levine
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Systemic Therapy ◽  
Odds Ratio ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Radical Mastectomy ◽  
Node Positive ◽  
Meta Analyses ◽  
Positive Breast Cancer

PURPOSE: Recent randomized trials in women with node-positive breast cancer who received systemic treatment report that locoregional radiation therapy improves survival. Previous trials failed to detect a difference in survival that results from its use. A systematic review of randomized trials that examine the effectiveness of locoregional radiation therapy in patients treated by definitive surgery and adjuvant systemic therapy was conducted. METHODS: Randomized trials published between 1967 and 1999 were identified through MEDLINE database, CancerLit database, and reference lists of relevant articles. Relevant data was abstracted. The results of randomized trials were pooled using meta-analyses to estimate the effect of treatment on any recurrence, locoregional recurrence, and mortality. RESULTS: Eighteen trials that involved a total of 6,367 patients were identified. Most trials included both pre- and postmenopausal women with node-positive breast cancer treated with modified radical mastectomy. The type of systemic therapy received, sites irradiated, techniques used, and doses of radiation delivered varied between trials. Data on toxicity were infrequently reported. Radiation was shown to reduce the risk of any recurrence (odds ratio, 0.69; 95% confidence interval [CI], 0.58 to 0.83), local recurrence (odds ratio, 0.25; 95% CI, 0.19 to 0.34), and mortality (odds ratio, 0.83; 95% CI, 0.74 to 0.94). CONCLUSION: Locoregional radiation after surgery in patients treated with systemic therapy reduced mortality. Several questions remain on how these results should be translated into current-day clinical practice.

scholarly journals Endocrine Therapy in Premenopausal Hormone Receptor–Positive Breast Cancer

2016 ◽  
Vol 12 (11) ◽  
pp. 1148-1156 ◽  
Author(s):  
Amye J. Tevaarwerk ◽  
Kari B. Wisinski ◽  
Ruth M. O’Regan
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Systemic Therapy ◽  
Hormone Receptor ◽  
Randomized Trials ◽  
Early Stage ◽  
Premenopausal Women ◽  
Breast Cancers ◽  
Hormone Receptor Positive ◽  
Positive Breast Cancer

Systemic therapy for premenopausal women with hormone receptor–positive breast cancer has evolved in the last 5 years, but critical questions remain. Recent randomized trials have demonstrated a benefit for the addition of ovarian suppression to endocrine therapy in patients with breast cancers considered to be at high risk for recurrence, whereas those with lower-risk cancers seem to have a favorable outcome with tamoxifen alone. Two large randomized trials have demonstrated a benefit for extending adjuvant tamoxifen beyond 5 years. Currently the choice of systemic therapy is selected empirically but molecular profiling may, in the near future, provide a more conclusive means of selecting an endocrine therapeutic approach for premenopausal patients. Given that a significant subset of hormone receptor–positive cancers are intrinsically resistant to endocrine agents, as well as the finding that inhibiting cyclin-dependent kinases 4 and 6 and mammalian target of rapamycin appears to potentially reverse this resistance in patients with metastatic disease, evaluation of these agents in the early-stage setting is ongoing.

scholarly journals Diagnostic Accuracy of Different Surgical Procedures for Axillary Staging After Neoadjuvant Systemic Therapy in Node-positive Breast Cancer

2019 ◽  
Vol 269 (3) ◽  
pp. 432-442 ◽  
Author(s):  
Janine M. Simons ◽  
Thiemo J. A. van Nijnatten ◽  
Carmen C. van der Pol ◽  
Ernest J. T. Luiten ◽  
Linetta B. Koppert ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Diagnostic Accuracy ◽  
Surgical Procedures ◽  
Systemic Therapy ◽  
Axillary Staging ◽  
Node Positive ◽  
Neoadjuvant Systemic Therapy ◽  
Positive Breast Cancer

Targeted axillary dissection after neoadjuvant systemic therapy in patients with node‐positive breast cancer

2019 ◽  
Vol 90 (3) ◽  
pp. 332-338
Author(s):  
Kavitha Kanesalingam ◽  
Nina Sriram ◽  
Ghaith Heilat ◽  
E ‐Ern Ng ◽  
Farid Meybodi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Systemic Therapy ◽  
Axillary Dissection ◽  
Node Positive ◽  
Neoadjuvant Systemic Therapy ◽  
Positive Breast Cancer

Predictive factors for omitting lymphadenectomy in patients with node‐positive breast cancer treated with neo‐adjuvant systemic therapy

2020 ◽  
Vol 26 (5) ◽  
pp. 888-896
Author(s):  
Sergi Fernandez‐Gonzalez ◽  
Catalina Falo ◽  
Maria J. Pla ◽  
Paula Verdaguer ◽  
Diana Nuñez ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Predictive Factors ◽  
Systemic Therapy ◽  
Adjuvant Systemic Therapy ◽  
Node Positive ◽  
Positive Breast Cancer

Adjuvant randomized trials of doxorubicin/cyclophosphamide versus doxorubicin/cyclophosphamide/tamoxifen and CMF chemotherapy versus tamoxifen in women with node-positive breast cancer.

1993 ◽  
Vol 11 (3) ◽  
pp. 454-460 ◽  
Author(s):  
M Kaufmann ◽  
W Jonat ◽  
U Abel ◽  
J Hilfrich ◽  
H Caffier ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Randomized Trials ◽  
Disease Free Survival ◽  
Good Prognosis ◽  
Low Risk ◽  
Lower Probability ◽  
Node Positive ◽  
Risk Patients ◽  
To Receive ◽  
Positive Breast Cancer

PURPOSE We report two randomized trials of adjuvant systemic therapy in 747 patients < or = 65 years of age with histologically proven node-positive breast cancer. PATIENTS AND METHODS Patients were selected for the two trials on the basis of lymph node and hormone receptor status. The only stratification was based on the treating institution. In patients with a lower probability of recurrence (n = 276), a comparison between endocrine therapy (tamoxifen [Tam] 30 mg/d for 2 years) and chemotherapy (cyclophosphamide, methotrexate, and fluorouracil [CMF] intravenously [IV], six cycles every 4 weeks) was performed. In patients with a higher risk of recurrence (n = 471), a comparison between chemotherapy alone (doxorubicin plus cyclophosphamide [AC] i.v., eight cycles every 3 weeks) and the same chemotherapy plus Tam was made. RESULTS Overall, we found that CMF and Tam are equally effective in a subgroup of patients with a relatively good prognosis (low-risk patients). However, in the subset of women < or = 49 years old, a significantly greater disease-free survival (DFS) rate (P = .01) and overall survival (OS) rate (P = .002) was observed following therapy with CMF compared with Tam. In patients > or = 50 years old, the opposite was found, and Tam appeared to be superior to CMF (DFS, P = .003; OSm P = .5). These results must be interpreted cautiously, since a post-hoc stratification of patients by age (< or = 49, > or = 50) was performed, and significantly more younger, low-risk patients were randomized to receive chemotherapy alone and more older patients to receive Tam alone. Among patients with a relatively poor prognosis (high-risk patients), a combination of AC plus Tam was equivalent to AC and, when women were analyzed by age, this was found to be true of patients < or = 49 years as well. However, the addition of Tam to AC in women age > or 50 years resulted in a statistically significantly higher DFS (P = .01) and a trend toward better OS compared with women who received AC alone. CONCLUSION Further trials are required to analyze the role of combined simultaneous or sequential chemoendocrine adjuvant treatment or each single therapy alone in defined risk-adapted subsets of node-negative and node-positive patients.

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