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ADJUVANT CHEMOTHERAPY PLUS RADIOTHERAPY FOR NODE-POSITIVE BREAST CANCER.

In previous trials, radiotherapy after mastectomy for breast cancer reduced the rate of locoregional recurrence but did not prolong survival. However, those trials generally did not use adjuvant chemotherapy, which has become the standard for many cases today.

This Danish study enrolled 1,708 premenopausal women with high-risk breast cancer (positive nodes, large tumor, or local invasion, but no evidence of metastases). The women were randomized to either adjuvant CMF chemotherapy alone (cyclophosphamide, methotrexate, fluorouracil) or CMF plus radiotherapy to the chest wall and regional nodes. During a median follow-up of 9.5 years, locoregional recurrence was reduced significantly with CMF plus irradiation, and estimated overall 10-year survival was significantly better with combined therapy than with CMF alone (54 vs. 45 percent).

A study from Canada yielded similar results in 318 premenopausal node-positive patients. During a median follow-up of 12.5 years, the rates of both locoregional and systemic disease-free survival were significantly higher with CMF/radiotherapy than CMF alone. Estimated overall 15-year survival was also better with combined therapy (54 vs. 46 percent); this difference was just shy of statistical significance, probably because of the small sample.

Comment: According to an editorialist, these results "suggest that all patients with positive nodes treated by mastectomy should have radiation therapy," usually combined with adjuvant chemotherapy.

— AS Brett

Published in Journal Watch General Medicine October 7, 1997

Citation(s):

Overgaard M et al. Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. N Engl J Med 1997 Oct 2 337 949-955.

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• Medline abstract (Free)

Ragaz J et al. Adjuvant radiotherapy and chemotherapy in node-positive premenopausal women with breast cancer. N Engl J Med 1997 Oct 2 337 956-962.

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• Medline abstract (Free)

Hellman S. Stopping metastases at their source. N Engl J Med 1997 Oct 2 337 996-997.

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• Medline abstract (Free)