l. vakaet 2006
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History of the randomized evidence on early breast cancer overall survival : Radiation vs no radiation after mastectomy. L. Vakaet 2006. The effect of RT on the chance of locoregional recurrence after mastectomy (node positive patients). Lancet 2005. Materials and methods (1/2). - PowerPoint PPT PresentationTRANSCRIPT
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History of the randomized evidence on early breast cancer overall survival:
Radiation vs no radiationafter mastectomy
L. Vakaet
2006
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The effect of RT on the chance of locoregional recurrence after mastectomy
(node positive patients)
Lancet 2005
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Materials and methods (1/2)• Only evidence from randomized clinical
trials (EBCTCG)
• All patients, in both arms, received mastectomy
• Only comparison is RT versus no RT
• First graph endpoint = locoregional recurrence
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Materials and methods• All other graphs endpoint = Overall Survival • Overall survival = Death after breast cancer
relapse (breast cancer mortality) + Other deaths (non-breast cancer mortality)
• All evidence (the good and the bad), no selection of only the « good » results (cfr only 5 yrs of tamoxifen!)
• First studies started in the 1950’s! Randomization by envelope.
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Overall SurvivalFirst RT vs no RT meta-analysis
Cuzick et al. Ca Tr Rep 1987, 3400 pts
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Follow-up after 10 years (1400 pts)
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Combined graph
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Second RT vs no RT meta-analysis Cuzick JCO 1994; (3362 pts)
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Survival with or without RT EBCTCG Lancet 2000 (5240 pts)
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Survival with or without RT EBCTCG Lancet 2000 (5240 pts)
EBCTCG Oxford 2000
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Jan Van de Steene
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Gebski et al. 2006
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Quality counts, also in RT (biologically equivalent dose)
Gebski et al. 2006
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An early example of treatment of breast cancer by irradiation (1908)
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Patient positioning
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Isocenter lines and fieldborders
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Simulation radiograph
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PLUNC isodoses in breast cancer
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Treatment techniques overview R&O 2002
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EBCTCG Lancet 2005;(9933 pts)
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EBCTCG Oxford 2006(6020 node positive pts)
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Indications for radiation treatment after mastectomy
• Poorly differentiated tumors
• T3 – T4 lesions
• Node positive patients:– 1 to 3 nodes positive: OS gain of 3% at 20
years (NNT = 33)– 4 or more nodes positive: OS gain of >8% at
20 years (NNT = 12)
• No importance: age and ER status.