Presentation on theme: "History of the randomized evidence on early breast cancer overall survival: Radiation vs no radiation after mastectomy L. Vakaet 2006."— Presentation transcript:
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) 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
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.
Overall Survival First RT vs no RT meta-analysis Cuzick et al. Ca Tr Rep 1987, 3400 pts
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.