دورية أكاديمية
Radiotherapy Use and Incidence of Locoregional Recurrence in Patients With Favorable-Risk, Node-Positive Breast Cancer Enrolled in the SWOG S1007 Trial.
| العنوان: | Radiotherapy Use and Incidence of Locoregional Recurrence in Patients With Favorable-Risk, Node-Positive Breast Cancer Enrolled in the SWOG S1007 Trial. |
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| المؤلفون: | Jagsi R; Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia., Barlow WE; SWOG, University of Washington, Seattle, Washington., Woodward WA; University of Texas MD Anderson Cancer Center, Houston., Connolly E; Columbia University, New York, New York., Mahtani R; Baptist Health South Florida, Miami., Shumway D; Mayo Clinic, Rochester, Minnesota., Speers C; Case Western Reserve University, Cleveland, Ohio., Stecklein SR; University of Kansas, Kansas City., Zeidan Y; Baptist Health South Florida, Boca Raton., Zhang H; University of Rochester, Rochester, New York., Sharma P; University of Kansas, Kansas City., Pusztai L; Yale University, New Haven, Connecticut., Hortobagyi GN; University of Texas MD Anderson Cancer Center, Houston., Kalinsky K; Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia. |
| المصدر: | JAMA oncology [JAMA Oncol] 2023 Aug 01; Vol. 9 (8), pp. 1083-1089. |
| نوع المنشور: | Randomized Controlled Trial; Journal Article; Research Support, Non-U.S. Gov't; Research Support, N.I.H., Extramural |
| اللغة: | English |
| بيانات الدورية: | Publisher: American Medical Association Country of Publication: United States NLM ID: 101652861 Publication Model: Print Cited Medium: Internet ISSN: 2374-2445 (Electronic) Linking ISSN: 23742437 NLM ISO Abbreviation: JAMA Oncol Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: Chicago, Il : American Medical Association, [2015]- |
| مواضيع طبية MeSH: | Breast Neoplasms*/radiotherapy , Breast Neoplasms*/drug therapy, Humans ; Female ; Middle Aged ; Mastectomy ; Incidence ; Neoplasm Recurrence, Local/pathology ; Mastectomy, Segmental ; Radiotherapy, Adjuvant |
| مستخلص: | Importance: Little is known about regional nodal irradiation (RNI) practice patterns or rates of locoregional recurrence (LRR) with and without RNI in patients with limited nodal disease and favorable biology treated with modern surgical and systemic therapy, including approaches that de-escalate those latter treatments. Objective: To investigate how often patients with low-recurrence score breast cancer with 1 to 3 nodes involved receive RNI, incidence and predictors of LRR, and associations between locoregional therapy and disease-free survival. Design, Setting, and Participants: In this secondary analysis of the SWOG S1007 trial, patients with hormone receptor-positive, ERBB2-negative breast cancer, and a Oncotype DX 21-gene Breast Recurrence Score assay result of no more than 25, were randomized to endocrine therapy alone vs chemotherapy then endocrine therapy. Prospectively collected radiotherapy information was collected from 4871 patients treated in diverse settings. Data were analyzed June 2022 to April 2023. Exposure: Receipt of RNI (targeting at least the supraclavicular region). Main Outcome(s) and Measure(s): Cumulative incidence of LRR was calculated by locoregional treatment received. Analyses were assessed for associations between invasive disease-free survival (IDFS) and locoregional therapy, adjusted for menopausal status, treatment group, recurrence score, tumor size, nodes involved, and axillary surgery. Radiotherapy information was recorded in the first year after randomization, so survival analyses were landmarked as starting at 1 year among those still at risk. Results: Of 4871 female patients (median [range] age, 57 [18-87] years) with radiotherapy forms, 3947 (81.0%) reported radiotherapy receipt. Of 3852 patients who received radiotherapy and had complete information on targets, 2274 (59.0%) received RNI. With a median follow-up of 6.1 years, the cumulative incidence of LRR by 5 years was 0.85% among patients who received breast-conserving surgery and radiotherapy with RNI; 0.55% after breast-conserving surgery with radiotherapy without RNI; 0.11% after mastectomy with postmastectomy radiotherapy; and 1.7% after mastectomy without radiotherapy. Similarly low LRR was observed within the group assigned to endocrine therapy without chemotherapy. The rate of IDFS did not differ by RNI receipt (premenopausal: hazard ratio [HR], 1.03; 95% CI, 0.74-1.43; P = .87; postmenopausal: HR, 0.85; 95% CI, 0.68-1.07; P = .16). Conclusions and Relevance: In this secondary analysis of a clinical trial, RNI use was divided in the setting of biologically favorable N1 disease, and rates of LRR were low even in patients who did not receive RNI. Disease-free survival was not associated with RNI receipt; omission of chemotherapy among patients similar to those enrolled in the S1007 trial is not an independent indication for use of RNI. |
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| معلومات مُعتمدة: | U10 CA180819 United States CA NCI NIH HHS; U10 CA180888 United States CA NCI NIH HHS; UG1 CA233160 United States CA NCI NIH HHS; UL1 TR001863 United States TR NCATS NIH HHS |
| تواريخ الأحداث: | Date Created: 20230706 Date Completed: 20230818 Latest Revision: 20240707 |
| رمز التحديث: | 20240707 |
| مُعرف محوري في PubMed: | PMC10326730 |
| DOI: | 10.1001/jamaoncol.2023.1984 |
| PMID: | 37410451 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 2374-2445 |
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| DOI: | 10.1001/jamaoncol.2023.1984 |