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| |  ASTRO: Routine Use of Regional Radiation May Result in Over-Treatment in Breast Cancer Patients By Charlene Laino SALT LAKE CITY, UT -- October 30, 2003 -- Routine use of regional radiation may expose some breast cancer patients to unnecessary treatment, suggests a study presented here on October 20th at the 45th Annual Meeting of the American Society for Therapeutic Radiology and Oncology. The study also showed that regional failures as first events are extremely rare in patients with no more than three positive lymph nodes, said lead researcher Alphonse G. Taghian, MD, PhD, Biostatistical Centers, speaking for the National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, Pennsylvania, United States. The goal of the study was to identify which breast cancer patients are at increased risk for axillary and supraclavicular recurrences if they are not treated with regional radiation, said Dr. Taghian, Assistant, Department of Radiation Oncology, Massachusetts General Hospital/Boston Medical Center, Boston, Massachusetts, United States. The study enrolled 3,788 patients with lymph-node-negative disease who were enrolled in the NASBP B-13, B-14, B-19, B-20 and B-23 trials and 2,337 patients with lymph-node-positive disease who were enrolled in the NSABP B-15, B-16, B-18, B-22 and B-25 trials. The patients received 50 Gy of radiation in 25 fractions to the breast; some also received a boost. None of the women received regional radiation. The 10-year cumulative incidences of regional failure for patients with lymph-node-negative disease and lymph-node-positive disease ranged from 0.9% to 1.9% and 4% to 14%, respectively, Dr. Taghian said. Supraclavicular recurrences were most common, affecting 59% of these women, he reported, with axillary recurrences in 31% of women with regional failure. The risk of supraclavicular failure was not associated with the number of lymph nodes removed, the study showed. However, "the number of lymph nodes removed was significantly associated with the risk of axillary failure," Dr. Taghian noted. Compared with women who had 10 or more nodes removed, those with 1 to 4 nodes removed were 5.7 times more likely to have an axillary recurrence (P<0.0001) and those with 6 to 9 nodes removed were 2.2 times more likely (P=0.03). In patients with lymph-node-negative disease, higher regional relapse rates were associated with younger age at diagnosis, the study showed. In the lymph-node-positive patients, "tumour size didn't add much over nodal status as a predictor," Dr. Taghian said. He concluded that, "regional failures as first events are very rare in N0 patients, affecting 2% at most. Even in node-positive patients with 1 to 3 involved nodes, only 4% have regional-failure first events." The value of regional radiotherapy in early-stage breast-cancer patients is currently being addressed in the randomised Phase III National Cancer Institute of Canada MA-20 trial, Dr. Taghian said.
[Study Title: Pattern of Regional Failure in Patients with Breast Cancer Treated by Lumpectomy, Breast Radiation ± Chemotherapy and/or Tamoxifen with No Regional Radiation: Results From 10 NSABP Randomized Trials. Abstract 74]
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