> Table 38: Radiation therapy following mastectomy and overall survival in stage II & III breast cancer
This summary table contains detailed information about research studies. Summary tables offer an informative look at the science behind many breast cancer guidelines and recommendations. However, they should be viewed with some caution. In order to read and interpret research tables successfully, it is important to understand some key concepts. Learn how to read a research table.
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Introduction: Radiation therapy is not often used after mastectomy for women with stage I or II breast cancer. However, it is recommended for women with four or more positive lymph nodes (and should be considered for women with one to three positive nodes) to improve survival [1].
Radiation therapy after mastectomy and survival
The results of two large randomized clinical trials with more than 10 years of follow-up suggest pre- and postmenopausal women with node-positive (stage II or III) breast cancer benefit from radiation therapy after mastectomy [2-3].
Radiation therapy after mastectomy lowers the risk of recurrence. Studies show it also improves overall survival in women at high risk of recurrence. A study that combined the results of 78 randomized treatment comparisons found radiation therapy lowered the risk of dying from breast cancer or any cause 15 years after treatment [4].
Radiation therapy and health risks
Older studies of radiation therapy show an increase in deaths from breast cancer in the opposite breast, heart disease and lung cancer [4]. Modern radiation therapy is given in lower doses than in the past and thus, these health risks appear to be much lower [5].
Data from recent studies of radiation therapy after breast surgery show no increased risk of breast cancer in the opposite breast [6-8]. For example, results from the Danish Breast Cancer Cooperative Group show no difference in rates of breast cancer in the opposite breast after 18 years of follow-up among women treated with radiation therapy after mastectomy and those not treated with radiation therapy [6].
Learn about the strengths and weaknesses of different types of studies.
Study selection criteria: Randomized clinical trials with at least 1,000 participants and 10 or more years of follow-up and meta-analyses.
Study
|
Study Population
(number of participants)
|
Stage of
Breast Cancer
|
Follow-up
(years)
|
Number of
Positive Nodes
|
Overall Survival
|
Percent Surviving—
Radiation Therapy after
Mastectomy
|
Percent Surviving—
No Radiation Therapy after
Mastectomy
|
Randomized clinical trials
|
DBCG 82b Trial [2]
|
1,708 premenopausal women
|
Stage II & III
|
10
|
1-3
|
62%
|
54%
|
| |
|
|
|
4 or more
|
32%
|
20%
|
DBCG 82c Trial [3]
|
1,375 postmenopausal women
|
Stage II & III
|
10
|
1-3
|
55%
|
44%
|
| |
|
|
|
4 or more
|
24%
|
17%
|
Meta-analyses
|
EBCTC [4]
|
8,505
|
Stage II & III
|
15
|
1 or more
|
40.2%
|
35.8%
|
| |
1,890
|
Stage II & III
|
15
|
1-3
|
48.9%
|
47.3%
|
| |
1,868
|
Stage II & III
|
15
|
4 or more
|
29.2%
|
27.6%
|
Gebski et al. [9]
|
6,946*
|
Stages I-III
|
10
|
1 or more
|
53%
|
47%†
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* Only included studies that used optimal radiation dosage and coverage
† Calculated from data in study
References
1. National Comprehensive Cancer Network. NCCN Clinical practice guidelines in oncology: Breast cancer, version 2.2011. http://www.nccn.org, 2011.
2. Overgaard M, Hansen PS, Overgaard J, et al. Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. Danish Breast Cancer Cooperative Group 82b Trial. N Engl J Med. 337:949-55, 1997.
3. Overgaard M, Jensen MB, Overgaard J, et al. Postoperative radiotherapy in high-risk postmenopausal breast cancer patients given adjuvant tamoxifen: Danish Breast Cancer Cooperative Group DBCG 82c randomised trial. Lancet. 353:1641-8, 1999.
4. Clarke M, Collins R, Darby S, et al. for the Early Breast Cancer Trialists' Collaborative Group. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 366(9503):2087-106, 2005.
5. Early Breast Cancer Trialists' Collaborative Group. Favourable and unfavourable effects on long-term survival of radiotherapy for early breast cancer: an overview of the randomised trials. Lancet. 355:1757-70, 2000.
6. Neilson HM, Overgaard M, Grau C, et al. Study of failure pattern among high-risk breast cancer patients with or without postmastectomy radiotherapy in addition to adjuvant systemic therapy: long-term results from the Danish Breast Cancer Cooperative Group DBCG 82 b and c randomized studies. J Clin Oncol. 24(15):2268-75, 2006.
7. Kirova YM, Gambotti L, De Rycke Y, Vilcoq JR, Asselain B, Fourquet A. Risk of second malignancies after adjuvant radiotherapy for breast cancer: a large-scale, single-institution review. Int J Radiat Oncol Biol Phys. 68(2):359-63, 2007.
8. Berrington de Gonzalez A, Curtis RE, Gilbert E, et al. Second solid cancers after radiotherapy for breast cancer in SEER cancer registries. Br J Cancer. 102(1):220-6, 2010.
9. Gebski V, Lagleva M, Keech A, et al. Survival effects of postmastectomy adjuvant radiation therapy using biologically equivalent doses: a clinical perspective. J Natl Cancer Inst. 98(1):26-38, 2006.
Updated 01/13/12
