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Article: Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10 801 women in 17 randomised trials

TitleEffect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10 801 women in 17 randomised trials
Authors
Issue Date2011
PublisherThe Lancet Publishing Group. The Journal's web site is located at http://www.elsevier.com/locate/lancet
Citation
The Lancet, 2011, v. 378 n. 9804, p. 1707-1716 How to Cite?
AbstractBACKGROUND: After breast-conserving surgery, radiotherapy reduces recurrence and breast cancer death, but it may do so more for some groups of women than for others. We describe the absolute magnitude of these reductions according to various prognostic and other patient characteristics, and relate the absolute reduction in 15-year risk of breast cancer death to the absolute reduction in 10-year recurrence risk. METHODS: We undertook a meta-analysis of individual patient data for 10,801 women in 17 randomised trials of radiotherapy versus no radiotherapy after breast-conserving surgery, 8337 of whom had pathologically confirmed node-negative (pN0) or node-positive (pN+) disease. FINDINGS: Overall, radiotherapy reduced the 10-year risk of any (ie, locoregional or distant) first recurrence from 35.0% to 19.3% (absolute reduction 15.7%, 95% CI 13.7-17.7, 2p<0.00001) and reduced the 15-year risk of breast cancer death from 25.2% to 21.4% (absolute reduction 3.8%, 1.6-6.0, 2p=0.00005). In women with pN0 disease (n=7287), radiotherapy reduced these risks from 31.0% to 15.6% (absolute recurrence reduction 15.4%, 13.2-17.6, 2p<0.00001) and from 20.5% to 17.2% (absolute mortality reduction 3.3%, 0.8-5.8, 2p=0.005), respectively. In these women with pN0 disease, the absolute recurrence reduction varied according to age, grade, oestrogen-receptor status, tamoxifen use, and extent of surgery, and these characteristics were used to predict large (>/=20%), intermediate (10-19%), or lower (<10%) absolute reductions in the 10-year recurrence risk. Absolute reductions in 15-year risk of breast cancer death in these three prediction categories were 7.8% (95% CI 3.1-12.5), 1.1% (-2.0 to 4.2), and 0.1% (-7.5 to 7.7) respectively (trend in absolute mortality reduction 2p=0.03). In the few women with pN+ disease (n=1050), radiotherapy reduced the 10-year recurrence risk from 63.7% to 42.5% (absolute reduction 21.2%, 95% CI 14.5-27.9, 2p<0.00001) and the 15-year risk of breast cancer death from 51.3% to 42.8% (absolute reduction 8.5%, 1.8-15.2, 2p=0.01). Overall, about one breast cancer death was avoided by year 15 for every four recurrences avoided by year 10, and the mortality reduction did not differ significantly from this overall relationship in any of the three prediction categories for pN0 disease or for pN+ disease. INTERPRETATION: After breast-conserving surgery, radiotherapy to the conserved breast halves the rate at which the disease recurs and reduces the breast cancer death rate by about a sixth. These proportional benefits vary little between different groups of women. By contrast, the absolute benefits from radiotherapy vary substantially according to the characteristics of the patient and they can be predicted at the time when treatment decisions need to be made. FUNDING: Cancer Research UK, British Heart Foundation, and UK Medical Research Council.
Persistent Identifierhttp://hdl.handle.net/10722/163924
ISSN
2015 Impact Factor: 44.002
2015 SCImago Journal Rankings: 14.638
PubMed Central ID
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorKwong, DLWen_US
dc.contributor.authorDarby, Sen_US
dc.contributor.authorMcGale, Pen_US
dc.contributor.authorCorrea, Cen_US
dc.contributor.authorTaylor, Cen_US
dc.contributor.authorArriagada, Ren_US
dc.contributor.authorClarke, Men_US
dc.contributor.authorCutter, Den_US
dc.contributor.authorDavies, Cen_US
dc.contributor.authorEwertz, Men_US
dc.contributor.authorGodwin, Jen_US
dc.contributor.authorGray, Ren_US
dc.contributor.authorPierce, Len_US
dc.contributor.authorWhelan, Ten_US
dc.contributor.authorWang, Yen_US
dc.contributor.authorPeter, Ren_US
dc.date.accessioned2012-09-20T07:53:14Z-
dc.date.available2012-09-20T07:53:14Z-
dc.date.issued2011en_US
dc.identifier.citationThe Lancet, 2011, v. 378 n. 9804, p. 1707-1716en_US
dc.identifier.issn0140-6736-
dc.identifier.urihttp://hdl.handle.net/10722/163924-
dc.description.abstractBACKGROUND: After breast-conserving surgery, radiotherapy reduces recurrence and breast cancer death, but it may do so more for some groups of women than for others. We describe the absolute magnitude of these reductions according to various prognostic and other patient characteristics, and relate the absolute reduction in 15-year risk of breast cancer death to the absolute reduction in 10-year recurrence risk. METHODS: We undertook a meta-analysis of individual patient data for 10,801 women in 17 randomised trials of radiotherapy versus no radiotherapy after breast-conserving surgery, 8337 of whom had pathologically confirmed node-negative (pN0) or node-positive (pN+) disease. FINDINGS: Overall, radiotherapy reduced the 10-year risk of any (ie, locoregional or distant) first recurrence from 35.0% to 19.3% (absolute reduction 15.7%, 95% CI 13.7-17.7, 2p<0.00001) and reduced the 15-year risk of breast cancer death from 25.2% to 21.4% (absolute reduction 3.8%, 1.6-6.0, 2p=0.00005). In women with pN0 disease (n=7287), radiotherapy reduced these risks from 31.0% to 15.6% (absolute recurrence reduction 15.4%, 13.2-17.6, 2p<0.00001) and from 20.5% to 17.2% (absolute mortality reduction 3.3%, 0.8-5.8, 2p=0.005), respectively. In these women with pN0 disease, the absolute recurrence reduction varied according to age, grade, oestrogen-receptor status, tamoxifen use, and extent of surgery, and these characteristics were used to predict large (>/=20%), intermediate (10-19%), or lower (<10%) absolute reductions in the 10-year recurrence risk. Absolute reductions in 15-year risk of breast cancer death in these three prediction categories were 7.8% (95% CI 3.1-12.5), 1.1% (-2.0 to 4.2), and 0.1% (-7.5 to 7.7) respectively (trend in absolute mortality reduction 2p=0.03). In the few women with pN+ disease (n=1050), radiotherapy reduced the 10-year recurrence risk from 63.7% to 42.5% (absolute reduction 21.2%, 95% CI 14.5-27.9, 2p<0.00001) and the 15-year risk of breast cancer death from 51.3% to 42.8% (absolute reduction 8.5%, 1.8-15.2, 2p=0.01). Overall, about one breast cancer death was avoided by year 15 for every four recurrences avoided by year 10, and the mortality reduction did not differ significantly from this overall relationship in any of the three prediction categories for pN0 disease or for pN+ disease. INTERPRETATION: After breast-conserving surgery, radiotherapy to the conserved breast halves the rate at which the disease recurs and reduces the breast cancer death rate by about a sixth. These proportional benefits vary little between different groups of women. By contrast, the absolute benefits from radiotherapy vary substantially according to the characteristics of the patient and they can be predicted at the time when treatment decisions need to be made. FUNDING: Cancer Research UK, British Heart Foundation, and UK Medical Research Council.-
dc.languageengen_US
dc.publisherThe Lancet Publishing Group. The Journal's web site is located at http://www.elsevier.com/locate/lancet-
dc.relation.ispartofThe Lanceten_US
dc.subject.meshBreast Neoplasms - mortality - therapy-
dc.subject.meshEstrogen Antagonists - therapeutic use-
dc.subject.meshLymphatic Metastasis-
dc.subject.meshMastectomy, Segmental-
dc.subject.meshNeoplasm Recurrence, Local - epidemiology-
dc.titleEffect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10 801 women in 17 randomised trialsen_US
dc.typeArticleen_US
dc.identifier.emailKwong, DLW: dlwkwong@hku.hken_US
dc.identifier.authorityKwong, DLW=rp00414en_US
dc.description.naturelink_to_OA_fulltext-
dc.identifier.doi10.1016/S0140-6736(11)61629-2-
dc.identifier.pmid22019144-
dc.identifier.pmcidPMC3254252-
dc.identifier.scopuseid_2-s2.0-81055155920-
dc.identifier.hkuros210085en_US
dc.identifier.volume378en_US
dc.identifier.issue9804en_US
dc.identifier.spage1707en_US
dc.identifier.epage1716en_US
dc.identifier.isiWOS:000296899800028-
dc.publisher.placeUnited Kingdom-
dc.identifier.f1000718493924-

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