DBCG-IMN: A Population-Based Cohort Study on the Effect of Internal Mammary Node Irradiation in Early Node-Positive Breast Cancer

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DOI

  • Lise Bech Jellesmark Thorsen
  • Birgitte Vrou Offersen
  • Hella Danø, Herlev Hospital, Danmark
  • Martin Berg, Vejle Sygehus, Danmark
  • Ingelise Jensen, Aalborg Universitetshospital, Danmark
  • Anders Navrsted Pedersen, Rigshospitalet, København, Danmark
  • Sune Jürg Zimmermann, Odense Universitetshospital, Danmark
  • Hans-Jürgen Brodersen, St Franziskus-hospital, Flensburg, Tyskland
  • Marie Overgaard
  • ,
  • Jens Overgaard
PURPOSE:
It is unknown whether irradiation of the internal mammary lymph nodes improves survival in patients with early-stage breast cancer. A possible survival benefit might be offset by radiation-induced heart disease. We assessed the effect of internal mammary node irradiation (IMNI) in patients with early-stage node-positive breast cancer.
PATIENTS AND METHODS:
In this nationwide, prospective population-based cohort study, we included patients who underwent operation for unilateral early-stage node-positive breast cancer. Patients with right-sided disease were allocated to IMNI, whereas patients with left-sided disease were allocated to no IMNI because of the risk of radiation-induced heart disease. The primary end point was overall survival. Secondary end points were breast cancer mortality and distant recurrence. Analyses were by intention to treat.
RESULTS:
A total of 3,089 patients were included. Of these, 1,492 patients were allocated to IMNI, whereas 1,597 patients were allocated to no IMNI. With a median of 8.9 years of follow-up time, the 8-year overall survival rates were 75.9% with IMNI versus 72.2% without IMNI. The adjusted hazard ratio (HR) for death was 0.82 (95% CI, 0.72 to 0.94; P = .005). Breast cancer mortality was 20.9% with IMNI versus 23.4% without IMNI (adjusted HR, 0.85; 95% CI, 0.73 to 0.98; P = .03). The risk of distant recurrence at 8 years was 27.4% with IMNI versus 29.7% without IMNI (adjusted HR, 0.89; 95% CI, 0.78 to 1.01; P = .07). The effect of IMNI was more pronounced in patients at high risk of internal mammary node metastasis. Equal numbers in each group died of ischemic heart disease.
CONCLUSION:
In this naturally allocated, population-based cohort study, IMNI increased overall survival in patients with early-stage node-positive breast cancer.
OriginalsprogEngelsk
TidsskriftJournal of Clinical Oncology
Vol/bind34
Nummer4
Sider (fra-til)314-20
Antal sider7
ISSN0732-183X
DOI
StatusUdgivet - 1 feb. 2016

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