Title |
Effects of Radiotherapy in Early-Stage, Low-Recurrence Risk, Hormone-Sensitive Breast Cancer.
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Published in |
JNCI: Journal of the National Cancer Institute, September 2018
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DOI | 10.1093/jnci/djy128 |
Pubmed ID | |
Authors |
Jinani Jayasekera, Clyde B Schechter, Joseph A Sparano, Reshma Jagsi, Julia White, Judith-Anne W Chapman, Timothy Whelan, Stewart J Anderson, Anthony W Fyles, Willi Sauerbrei, Richard C Zellars, Yisheng Li, Juhee Song, Xuelin Huang, Thomas B Julian, George Luta, Donald A Berry, Eric J Feuer, Jeanne Mandelblatt |
Abstract |
Radiotherapy after breast conservation has become the standard of care. Prior meta-analyses on effects of radiotherapy predated availability of gene expression profiling (GEP) to assess recurrence risk and/or did not include all relevant outcomes. This analysis used GEP information with pooled individual-level data to evaluate the impact of omitting radiotherapy on recurrence and mortality. We considered trials that evaluated or administered radiotherapy after lumpectomy in women with low-risk breast cancer. Women included had undergone lumpectomy and were treated with hormonal therapy for stage I, ER+ and/or PR+, HER2- breast cancer with Oncotype scores no greater than 18. Recurrence-free interval (RFI), type of RFI (locoregional or distant), and breast cancer-specific and overall survival were compared between no radiotherapy and radiotherapy using adjusted Cox models. All statistical tests were two-sided. The final sample included 1778 women from seven trials. Omission of radiotherapy was associated with an overall adjusted hazard ratio of 2.59 (95% confidence interval [CI] = 1.38 to 4.89, P = .003) for RFI. There was a statistically significant increase in any first locoregional recurrence (P = .001), but not distant recurrence events (P = .90), or breast cancer-specific (P = .85) or overall survival (P = .61). Five-year RFI rate was high (93.5% for no radiotherapy vs 97.9% for radiotherapy; absolute reduction = 4.4%, 95% CI = 0.7% to 8.1%, P = .03). The effects of radiotherapy varied across subgroups, with lower RFI rates for those with Oncotype scores of less than 11 (vs 11-18), older (vs younger), and ER+/PR+ status (vs other). Omission of radiotherapy in hormone-sensitive patients with low recurrence risk may lead to a modest increase in locoregional recurrence event rates, but does not appear to increase the rate of distant recurrence or death. |
X Demographics
Geographical breakdown
Country | Count | As % |
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Spain | 5 | 42% |
United States | 2 | 17% |
Unknown | 5 | 42% |
Demographic breakdown
Type | Count | As % |
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Members of the public | 11 | 92% |
Science communicators (journalists, bloggers, editors) | 1 | 8% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 54 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Other | 7 | 13% |
Researcher | 7 | 13% |
Student > Ph. D. Student | 4 | 7% |
Student > Master | 4 | 7% |
Lecturer | 3 | 6% |
Other | 14 | 26% |
Unknown | 15 | 28% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 19 | 35% |
Pharmacology, Toxicology and Pharmaceutical Science | 3 | 6% |
Agricultural and Biological Sciences | 2 | 4% |
Nursing and Health Professions | 2 | 4% |
Biochemistry, Genetics and Molecular Biology | 2 | 4% |
Other | 6 | 11% |
Unknown | 20 | 37% |