Ten-Year Survival after Postmastectomy Chest-Wall Irradiation in Breast Cancer
Year: 2025
Type: article
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: BACKGROUND: The role of postmastectomy chest-wall irradiation in patients with breast cancer classified as pN1 (with involvement of one to three axillary nodes) or pN0 (pathologically node negative) with additional risk factors is uncertain. METHODS: In this international, phase 3, randomized trial, we evaluated the omission of chest-wall irradiation in women with "intermediate-risk" breast cancer - defined as cancer that was stage pT1N1, pT2N1, or pT3N0 or stage pT2N0 with a histologic grade of 3, lymphovascular invasion, or both (tumor size: T1, ≤2 cm; T2, >2 cm to 5 cm; or T3, >5 cm) - that was treated with mastectomy, an axillary procedure, and systemic therapy. Patients were assigned to undergo chest-wall irradiation (40 to 50 Gy; the irradiation group) or not to undergo chest-wall irradiation (the no-irradiation group). The primary end point was overall survival, with 10 years of follow-up. Chest-wall recurrence, regional recurrence, disease-free survival, distant metastasis-free survival, causes of death, and radiation-related adverse events were also assessed. RESULTS: The intention-to-treat population included 808 patients in the irradiation group and 799 in the no-irradiation group. The median follow up was 9.6 years. Overall survival was 81.4% with chest-wall irradiation and 81.9% with no chest-wall irradiation according to 10-year Kaplan-Meier estimates (hazard ratio for death, 1.04; 95% confidence interval [CI], 0.82 to 1.30; P = 0.80). A total of 29 patients had a chest-wall recurrence - 9 (1.1%) in the irradiation group and 20 (2.5%) in the no-irradiation group (between-group difference, <2 percentage points; hazard ratio, 0.45; 95% CI, 0.20 to 0.99). Disease-free survival was 76.2% in the irradiation group and 75.5% in the no-irradiation group (hazard ratio for recurrence or death, 0.97; 95% CI, 0.79 to 1.18), and distant metastasis-free survival was 78.2% and 79.2%, respectively (hazard ratio for distant metastasis or death, 1.06; 95% CI, 0.86 to 1.31). CONCLUSIONS: In this trial, chest-wall irradiation did not result in higher overall survival than no chest-wall irradiation among patients with intermediate-risk, early breast cancer treated with mastectomy and contemporary adjuvant systemic therapy. (Funded by the Medical Research Council and others; SUPREMO ISRCTN Clinical Study Registry number, 61145589.).
Source: New England Journal of Medicine
Authors: Ian H. Kunkler, Nicola S. Russell, Niall Anderson, Richard Sainsbury, J. Michael Dixon, David Cameron, Juliette Loncaster, Matthew Hatton, Helen Westenberg, Jackie Clarke, Heather McCarty, Rhun Evans, Konstantinos Geropantas, Virginia Wolstenholme, Abdulla Alhasso, Pamela Woodings, Lisa Barraclough, Neil Bayman, Richard Welch, Fidelis Muturi, Tracy McEleney, Jacqueline Burns, Kathleen Riddle, Eve Macdonald, Joanna Dunlop, Nicole Sergenson, Geertjan van Tienhoven, Karen J. Taylor, John M.S. Bartlett, Tammy Piper, Galina Velikova, Edwin Aird, Boon Chua, Coen Hurkmans, Karen Venables, Linda J. Williams, Jeremy S. Thomas, Andrew M. Hanby, Marjory Maclennan, Susan Cleator, Eldo T. Verghese, Yexiong Li, Shulian Wang, Peter Canney
Institutions: Institute of Genetics and Cancer, University of Edinburgh, The Netherlands Cancer Institute, University College London, Western General Hospital, The Christie Hospital, The Christie NHS Foundation Trust, Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Radiotherapiegroep, Belfast Health and Social Care Trust, Belfast City Hospital, Norfolk and Norwich University Hospital, Barts Health NHS Trust, Beatson West of Scotland Cancer Centre, Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Bolton NHS Foundation Trust, Royal Bolton Hospital, Public Health Scotland, University of Aberdeen, Amsterdam University Medical Centers, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Hillingdon Hospitals NHS Foundation Trust, Mount Vernon Hospital, UNSW Sydney, Catharina Ziekenhuis, NHS Lothian, Imperial College Healthcare NHS Trust, Chinese Academy of Medical Sciences & Peking Union Medical College
Language: English
Subfield: Cancer Research
Domain: Life Sciences
Open Access status: green
Funder: Medical Research Council
Award: G5566846405
OpenAlex ID: W4415992007