Postmastectomy Radiation Therapy in Women with T1-T2 Tumors and 1 to 3 Positive Lymph Nodes: Analysis of the Breast International Group 02-98 Trial

Youssef Zeidan, Joyce G. Habib, Lieveke Ameye, Marianne Paesmans, Evandro de Azambuja, Richard D. Gelber, Ian Campbell, Bo Nordenskjöld, Jorge Gutiérez, Michael Anderson, Ana Lluch, Michael Gnant, Aron Goldhirsch, Angelo Di Leo, David J. Joseph, John Crown, Martine Piccart-Gebhart, Prudence A. Francis

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Abstract

Purpose: To analyze the impact of postmastectomy radiation therapy (PMRT) for patients with T1-T2 tumors and 1 to 3 positive lymph nodes enrolled on the Breast International Group (BIG) 02-98 trial. Methods and Materials: The BIG 02-98 trial randomized patients to receive adjuvant anthracycline with or without taxane chemotherapy. Delivery of PMRT was nonrandomized and performed according to institutional preferences. The present analysis was performed on participants with T1-T2 breast cancer and 1 to 3 positive lymph nodes who had undergone mastectomy and axillary nodal dissection. The primary objective of the present study was to examine the effect of PMRT on risk of locoregional recurrence (LRR), breast cancer-specific survival, and overall survival. Results: We identified 684 patients who met the inclusion criteria and were included in the analysis, of whom 337 (49%) had received PMRT. At 10 years, LRR risk was 2.5% in the PMRT group and 6.5% in the no-PMRT group (hazard ratio 0.29, 95% confidence interval 0.12-0.73; P = .005). Lower LRR after PMRT was noted for patients randomized to receive adjuvant chemotherapy with no taxane (10-year LRR: 3.4% vs 9.1%; P = .02). No significant differences in breast cancer-specific survival (84.3% vs 83.9%) or overall survival (81.7% vs 78.3%) were observed according to receipt of PMRT. Conclusion: Our analysis of the BIG 02-98 trial shows excellent outcomes in women with T1-T2 tumors and 1 to 3 positive lymph nodes found in axillary dissection. Although PMRT improved LRR in this cohort, the number of events remained low at 10 years. In all groups, 10-year rates of LRR were relatively low compared with historical studies. As such, the use of PMRT in women with 1 to 3 positive nodes should be tailored to individual patient risks.

Original languageEnglish (US)
JournalInternational Journal of Radiation Oncology Biology Physics
DOIs
StateAccepted/In press - Jan 1 2018
Externally publishedYes

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lymphatic system
breast
radiation therapy
Breast
Radiotherapy
tumors
Lymph Nodes
Neoplasms
Recurrence
dissection
Survival
cancer
chemotherapy
Breast Neoplasms
Dissection
Anthracyclines
Mastectomy
Adjuvant Chemotherapy
hazards
confidence

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

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Postmastectomy Radiation Therapy in Women with T1-T2 Tumors and 1 to 3 Positive Lymph Nodes : Analysis of the Breast International Group 02-98 Trial. / Zeidan, Youssef; Habib, Joyce G.; Ameye, Lieveke; Paesmans, Marianne; de Azambuja, Evandro; Gelber, Richard D.; Campbell, Ian; Nordenskjöld, Bo; Gutiérez, Jorge; Anderson, Michael; Lluch, Ana; Gnant, Michael; Goldhirsch, Aron; Di Leo, Angelo; Joseph, David J.; Crown, John; Piccart-Gebhart, Martine; Francis, Prudence A.

In: International Journal of Radiation Oncology Biology Physics, 01.01.2018.

Research output: Contribution to journalArticle

Zeidan, Y, Habib, JG, Ameye, L, Paesmans, M, de Azambuja, E, Gelber, RD, Campbell, I, Nordenskjöld, B, Gutiérez, J, Anderson, M, Lluch, A, Gnant, M, Goldhirsch, A, Di Leo, A, Joseph, DJ, Crown, J, Piccart-Gebhart, M & Francis, PA 2018, 'Postmastectomy Radiation Therapy in Women with T1-T2 Tumors and 1 to 3 Positive Lymph Nodes: Analysis of the Breast International Group 02-98 Trial', International Journal of Radiation Oncology Biology Physics. https://doi.org/10.1016/j.ijrobp.2018.01.105
Zeidan, Youssef ; Habib, Joyce G. ; Ameye, Lieveke ; Paesmans, Marianne ; de Azambuja, Evandro ; Gelber, Richard D. ; Campbell, Ian ; Nordenskjöld, Bo ; Gutiérez, Jorge ; Anderson, Michael ; Lluch, Ana ; Gnant, Michael ; Goldhirsch, Aron ; Di Leo, Angelo ; Joseph, David J. ; Crown, John ; Piccart-Gebhart, Martine ; Francis, Prudence A. / Postmastectomy Radiation Therapy in Women with T1-T2 Tumors and 1 to 3 Positive Lymph Nodes : Analysis of the Breast International Group 02-98 Trial. In: International Journal of Radiation Oncology Biology Physics. 2018.
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abstract = "Purpose: To analyze the impact of postmastectomy radiation therapy (PMRT) for patients with T1-T2 tumors and 1 to 3 positive lymph nodes enrolled on the Breast International Group (BIG) 02-98 trial. Methods and Materials: The BIG 02-98 trial randomized patients to receive adjuvant anthracycline with or without taxane chemotherapy. Delivery of PMRT was nonrandomized and performed according to institutional preferences. The present analysis was performed on participants with T1-T2 breast cancer and 1 to 3 positive lymph nodes who had undergone mastectomy and axillary nodal dissection. The primary objective of the present study was to examine the effect of PMRT on risk of locoregional recurrence (LRR), breast cancer-specific survival, and overall survival. Results: We identified 684 patients who met the inclusion criteria and were included in the analysis, of whom 337 (49{\%}) had received PMRT. At 10 years, LRR risk was 2.5{\%} in the PMRT group and 6.5{\%} in the no-PMRT group (hazard ratio 0.29, 95{\%} confidence interval 0.12-0.73; P = .005). Lower LRR after PMRT was noted for patients randomized to receive adjuvant chemotherapy with no taxane (10-year LRR: 3.4{\%} vs 9.1{\%}; P = .02). No significant differences in breast cancer-specific survival (84.3{\%} vs 83.9{\%}) or overall survival (81.7{\%} vs 78.3{\%}) were observed according to receipt of PMRT. Conclusion: Our analysis of the BIG 02-98 trial shows excellent outcomes in women with T1-T2 tumors and 1 to 3 positive lymph nodes found in axillary dissection. Although PMRT improved LRR in this cohort, the number of events remained low at 10 years. In all groups, 10-year rates of LRR were relatively low compared with historical studies. As such, the use of PMRT in women with 1 to 3 positive nodes should be tailored to individual patient risks.",
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T2 - Analysis of the Breast International Group 02-98 Trial

AU - Zeidan, Youssef

AU - Habib, Joyce G.

AU - Ameye, Lieveke

AU - Paesmans, Marianne

AU - de Azambuja, Evandro

AU - Gelber, Richard D.

AU - Campbell, Ian

AU - Nordenskjöld, Bo

AU - Gutiérez, Jorge

AU - Anderson, Michael

AU - Lluch, Ana

AU - Gnant, Michael

AU - Goldhirsch, Aron

AU - Di Leo, Angelo

AU - Joseph, David J.

AU - Crown, John

AU - Piccart-Gebhart, Martine

AU - Francis, Prudence A.

PY - 2018/1/1

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N2 - Purpose: To analyze the impact of postmastectomy radiation therapy (PMRT) for patients with T1-T2 tumors and 1 to 3 positive lymph nodes enrolled on the Breast International Group (BIG) 02-98 trial. Methods and Materials: The BIG 02-98 trial randomized patients to receive adjuvant anthracycline with or without taxane chemotherapy. Delivery of PMRT was nonrandomized and performed according to institutional preferences. The present analysis was performed on participants with T1-T2 breast cancer and 1 to 3 positive lymph nodes who had undergone mastectomy and axillary nodal dissection. The primary objective of the present study was to examine the effect of PMRT on risk of locoregional recurrence (LRR), breast cancer-specific survival, and overall survival. Results: We identified 684 patients who met the inclusion criteria and were included in the analysis, of whom 337 (49%) had received PMRT. At 10 years, LRR risk was 2.5% in the PMRT group and 6.5% in the no-PMRT group (hazard ratio 0.29, 95% confidence interval 0.12-0.73; P = .005). Lower LRR after PMRT was noted for patients randomized to receive adjuvant chemotherapy with no taxane (10-year LRR: 3.4% vs 9.1%; P = .02). No significant differences in breast cancer-specific survival (84.3% vs 83.9%) or overall survival (81.7% vs 78.3%) were observed according to receipt of PMRT. Conclusion: Our analysis of the BIG 02-98 trial shows excellent outcomes in women with T1-T2 tumors and 1 to 3 positive lymph nodes found in axillary dissection. Although PMRT improved LRR in this cohort, the number of events remained low at 10 years. In all groups, 10-year rates of LRR were relatively low compared with historical studies. As such, the use of PMRT in women with 1 to 3 positive nodes should be tailored to individual patient risks.

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