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

IF 4.9 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology Pub Date : 2024-09-26 DOI:10.1016/j.radonc.2024.110563

Orit Kaidar-Person , Liesbeth J. Boersma , Peter De Brouwer , Caroline Weltens , Carine Kirkove , Karine Peignaux-Casasnovas , Volker Budach , Femke van der Leij , Max Peters , Nicola Weidner , Sofia Rivera , Geertjan van Tienhoven , Alain Fourquet , Georges Noel , Mariacarla Valli , Matthias Guckenberger , Eveline Koiter , Severine Racadot , Roxolyana Abdah-Bortnyak , Harry Bartelink , Philip M. Poortmans

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引用次数: 0

Abstract

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.

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EORTC 22922/10925 试验调查了 I-III 期乳腺癌的区域性结节照射：根据局部和全身疗法得出的结果。

EORTC 22922/10925试验旨在研究乳腺癌I-III期患者选择性乳腺内和锁骨上内侧（IM-MS）放疗（RT）对总生存期（OS）的影响。原发肿瘤和腋窝淋巴结手术、胸壁RT、保乳治疗（BCT）中全乳RT后的增强RT、手术腋窝RT以及全身治疗均由医生决定。目前的分析旨在根据试验中使用的不同局部和全身疗法评估乳腺癌的治疗效果：从试验的病例报告表中提取了中位随访15.7年的数据。制作了无病生存期和总生存期的卡普兰-梅耶尔曲线以及乳腺癌事件的累积发生率曲线。使用 Cox 模型或 Fine & Gray 模型（考虑竞争风险）对局部和全身治疗类型对乳腺癌预后的影响进行了探索性分析，这两种模型都对患者和疾病的基线特征以及治疗方法进行了调整。显著性水平设定为 5%，双侧：在纳入的 4004 例患者中，625 例（16%）术后未接受任何系统治疗，1185 例（30%）仅接受内分泌治疗，994 例（25%）仅接受化疗，1200 例（30%）同时接受化疗和内分泌治疗，随机分组之间无差异。治疗方法和类型与年龄、绝经状态、临床T期和N期以及ER状态有关（P 结论：不同的治疗方法会影响雌激素水平：不同的治疗方法会影响首次发病的部位。IM-MS RT改善了不同乳腺癌的治疗效果，这很可能与试验臂和分层方法造成的组间平衡有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Radiotherapy and Oncology 医学-核医学

CiteScore

10.30

自引率

10.50%

发文量

2445

审稿时长

45 days

期刊介绍： Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.