1. History of the randomized evidence on early breast cancer overall survival: Radiation vs no radiation after mastectomy L. Vakaet 2006

2. The effect of RT on the chance of locoregional recurrence after mastectomy (node positive patients) Lancet 2005

3. 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

4. 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.

5. Overall Survival First RT vs no RT meta-analysis Cuzick et al. Ca Tr Rep 1987, 3400 pts

6. Follow-up after 10 years (1400 pts)

7. Combined graph

8. Second RT vs no RT meta-analysis Cuzick JCO 1994; (3362 pts)

9. Survival with or without RT EBCTCG Lancet 2000 (5240 pts)

10. EBCTCG Oxford 2000

11. Jan Van de Steene

12. Gebski et al. 2006

13. Quality counts, also in RT (biologically equivalent dose) Gebski et al. 2006

14. An early example of treatment of breast cancer by irradiation (1908)

15. Patient positioning

16. Isocenter lines and fieldborders

17. Simulation radiograph

18. PLUNC isodoses in breast cancer

19. Treatment techniques overview R&O 2002

20. EBCTCG Lancet 2005; (9933 pts)

21. EBCTCG Oxford 2006 (6020 node positive pts)

24. 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.