Abstracts of Current Literature
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Spring / Printemps 2005 Volume 36 Number / Numéro 1 The Canadian Journal of Medical Radiation Technology Fyles A., McCready D.R., Manchul L.A., et al New England Journal of Medicine, 2004, Vol. 351, No.10, pp 963-970 ABSTRACT BACKGROUND: We determined the effect of breast irradiation plus tamoxifen on disease-free survival and local relapse in women 50 years of age or older who had T1 or T2 node-negative breast cancer. METHODS: Between December 1992 and June 2000, 769 women with early breast cancer (tumor diameter, 5 cm or less) were randomly assigned to receive breast irradiation plus tamoxifen (386 women) or tamoxifen alone (383 women). The median follow-up was 5.6 years. RESULTS: The rate of local relapse at 5 years was 7.7 percent in the tamoxifen group and 0.6 percent in the group given tamoxifen plus irradiation (hazard ratio, 8.3; 95 percent confidence interval, 3.3 to 21.2; P<0.001), with corresponding 5-year disease-free survival rates of 84 percent and 91 percent (P=0.004). A planned subgroup analysis of 611 women with T1, receptor-positive tumors indicated a benefit from radiotherapy (5-year rates of local relapse, 0.4 percent with tamoxifen plus radiotherapy and 5.9 percent with tamoxifen alone; P<0.001). Overall, there was a significant difference in the rate of axillary relapse at 5 years (2.5 percent in the tamoxifen group and 0.5 percent in the group given tamoxifen plus irradiation, P=0.049), but no significant difference in the rates of distant relapse or overall survival. CONCLUSIONS: As compared with tamoxifen alone, radiotherapy plus tamoxifen significantly reduces the risk of breast and axillary recurrence after lumpectomy in women with small, node-negative, hormone-receptor–positive breast cancers Hughes K.S., Schnaper L.A., Berry D., et al New England Journal of Medicine, 2004, Vol. 10, No 351, pp 971-977 ABSTRACT BACKGROUND: In women 70 years of age or older who have early breast cancer, it is unclear whether lumpectomy plus tamoxifen is as effective as lumpectomy followed by tamoxifen plus radiation therapy. METHODS: Between July 1994 and February 1999, we randomly assigned 636 women who were 70 years of age or older and who had clinical stage I (T1N0M0 according to the tumor–node–metastasis classification), estrogen-receptor–positive breast carcinoma treated by lumpectomy to receive tamoxifen plus radiation therapy (317 women) or tamoxifen alone (319 women). Primary end points were the time to local or regional recurrence, the frequency of mastectomy for recurrence, breast-cancer–specific survival, the time to distant metastasis, and overall survival. RESULTS: The only significant difference between the two groups was in the rate of local or regional recurrence at 5 years (1 percent in the group given tamoxifen plus irradiation and 4 percent in the group given tamoxifen alone, P<0.001). There were no significant differences between the two groups with regard to the rates of mastectomy for local recurrence, distant metastases, or 5-year rates of overall survival (87 percent in the group given tamoxifen plus irradiation and 86 percent in the tamoxifen group, P=0.94). Assessment by physicians and patients of cosmetic results and adverse events uniformly rated tamoxifen plus irradiation inferior to tamoxifen alone. CONCLUSIONS: Lumpectomy plus adjuvant therapy with tamoxifen alone is a realistic choice for the treatment of women 70 years of age or older who have early, estrogen-receptor–positive breast cancer. Probst H., Dodwell D., Gray J., Holmes M. Radiography, 2005, Vol. 11, pp 3-9 ABSTRACT PURPOSE: Treatment for early breast cancer is multimodal with radiotherapy playing a fundamental role. This study investigated the relationship between the depth of lung incorporated in the tangential chest wall fields and self-reported respiratory symptoms. METHOD: A randomized trial was conducted with 350 patients from one radiotherapy centre, randomized to one of two lung depth categories (0–2 cm or 0–2.5 cm). The primary outcome measure was the self-reported incidence of dry unproductive cough (DUC) post-treatment. RESULTS: On an intention to treat basis no difference in post-treatment symptoms for DUC could be identified between the two lung depth categories. A logistic regression analysis identified patient age, the use of nodal irradiation, and symptoms of DUC pre- treatment as significant in determining the risk of patients developing symptoms post-treatment. CONCLUSION: These results confirm the importance of considering total volume of lung incorporated in the radiotherapy portals (identified by the relationship between reported symptoms and the use of nodal irradiation). The results of this study serve to further emphasize the need for evidence-based study into the radiotherapy policies employed in the UK. ABSTRACTS OF CURRENT LITERATURE
Transcript of Abstracts of Current Literature
Spring / Printemps 2005 Volume 36 Number / Numéro 1
The Canadian Journal of Medical Radiation Technology
Fyles A., McCready D.R., Manchul L.A., et alNew England Journal of Medicine, 2004, Vol. 351, No.10, pp 963-970
ABSTRACTBACKGROUND: We determined the effect of breast irradiation plus tamoxifen on disease-free survival and local relapse in women 50 years of age or older who had T1 or T2 node-negative breast cancer. METHODS: Between December 1992 and June 2000, 769 women with early breast cancer (tumor diameter, 5 cm or less) were randomly assigned to receive breast irradiation plus tamoxifen (386 women) or tamoxifen alone (383 women). The median follow-up was 5.6 years. RESULTS: The rate of local relapse at 5 years was 7.7 percent in the tamoxifen group and 0.6 percent in the group given tamoxifen plus irradiation (hazard ratio, 8.3; 95 percent confidence interval, 3.3 to 21.2; P<0.001), with corresponding 5-year disease-free survival rates of 84 percent and 91 percent (P=0.004). A planned subgroup analysis of 611 women with T1, receptor-positive tumors indicated a benefit from radiotherapy (5-year rates of local relapse, 0.4 percent with tamoxifen plus radiotherapy and 5.9 percent with tamoxifen alone; P<0.001). Overall, there was a significant difference in the rate of axillary relapse at 5 years (2.5 percent in the tamoxifen group and 0.5 percent in the group given tamoxifen plus irradiation, P=0.049), but no significant difference in the rates of distant relapse or overall survival. CONCLUSIONS: As compared with tamoxifen alone, radiotherapy plus tamoxifen significantly reduces the risk of breast and axillary recurrence after lumpectomy in women with small, node-negative, hormone-receptor–positive breast cancers
Hughes K.S., Schnaper L.A., Berry D., et alNew England Journal of Medicine, 2004, Vol. 10, No 351, pp 971-977
ABSTRACT BACKGROUND: In women 70 years of age or older who have early breast cancer, it is unclear whether lumpectomy plus tamoxifen is as effective as lumpectomy followed by tamoxifen plus radiation therapy. METHODS: Between July 1994 and February 1999, we randomly assigned 636 women who were 70 years of age or older and who had clinical stage I (T1N0M0 according to the tumor–node–metastasis classification), estrogen-receptor–positive breast carcinoma treated by lumpectomy to receive tamoxifen plus radiation therapy (317 women) or tamoxifen alone (319 women). Primary end points were the time to local or regional recurrence, the frequency of mastectomy for recurrence, breast-cancer–specific survival, the time to distant metastasis, and overall survival. RESULTS: The only significant difference between the two groups was in the rate of local or regional recurrence at 5 years (1 percent in the group given tamoxifen plus irradiation and 4 percent in the group given tamoxifen alone, P<0.001). There were no significant differences between the two groups with regard to the rates of mastectomy for local recurrence, distant metastases, or 5-year rates of overall survival (87 percent in the group given tamoxifen plus irradiation and 86 percent in the tamoxifen group, P=0.94). Assessment by physicians and patients of cosmetic results and adverse events uniformly rated tamoxifen plus irradiation inferior to tamoxifen alone. CONCLUSIONS: Lumpectomy plus adjuvant therapy with tamoxifen alone is a realistic choice for the treatment of women 70 years of age or older who have early, estrogen-receptor–positive breast cancer.
Probst H., Dodwell D., Gray J., Holmes M.Radiography, 2005, Vol. 11, pp 3-9
ABSTRACTPURPOSE: Treatment for early breast cancer is multimodal with radiotherapy playing a fundamental role. This study investigated the relationship between the depth of lung incorporated in the tangential chest wall fields and self-reported respiratory symptoms. METHOD: A randomized trial was conducted with 350 patients from one radiotherapy centre, randomized to one of two lung depth categories (0–2 cm or 0–2.5 cm). The primary outcome measure was the self-reported incidence of dry unproductive cough (DUC) post-treatment. RESULTS: On an intention to treat basis no difference in post-treatment symptoms for DUC could be identified between the two lung depth categories. A logistic regression analysis identified patient age, the use of nodal irradiation, and symptoms of DUC pre-treatment as significant in determining the risk of patients developing symptoms post-treatment. CONCLUSION: These results confirm the importance of considering total volume of lung incorporated in the radiotherapy portals (identified by the relationship between reported symptoms and the use of nodal irradiation). The results of this study serve to further emphasize the need for evidence-based study into the radiotherapy policies employed in the UK.
ABSTRACTS OF CURRENT LITERATURE
