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• W2088894222 abstract "Sir-An important finding of the Early Breast Cancer Trialists' Collaborative Group (EBCTCG) overview (May 20, p 1757),1Early Breast Cancer Trialists' Collaborative GroupFavourable and unfavourable effects on long-term survival of radiotherapy for early breast cancer: an overview of the randomised trials.Lancet. 2000; 355: 1757-1770Summary Full Text Full Text PDF PubMed Scopus (1183) Google Scholar which is not highlighted by the trialists, is that the survival advantage conferred by radiotherapy appears to be inversely proportional to the adequacy of locoregional surgical treatment. Their figure 1 shows that the benefit of radiotherapy was evident only in patients with positive lymph nodes on axillary sampling who had no further surgery (primarily the Danish trials). Assuming inadequate treatment of the axilla to be more hazardous than inadequate treatment of the breast, the trend for overall survival differences conferred by radiotherapy among the different surgical groups is exactly as one would expect: mastectomy with axillary sampling, plus 17%; lumpectomy with axillary clearance, plus 6%; mastectomy in clinically node-negative patients, plus 2%; and mastectomy with axillary clearance, minus 4%. Therefore, the Danish trials may prove only that adequate locoregional treatment is important to survival, irrespective of whether that treatment includes surgery or radiotherapy. The EBCTCG note the heterogeneity of the effect of radiotherapy on survival with regard to the surgical treatment group, and then state: “there may, however, be more informative ways of subdividing the overall mortality findings”. I disagree. Their suggestion that radiotherapy confers an early advantage by improving locoregional control and a late disadvantage by increasing cardiovascular mortality is certainly cogent and clinically useful, but it does not make the differences due to surgical treatment any less compelling. The EBCTCG data give us no reason to believe that adding radiation therapy to modified radical mastectomy is of benefit and suggest that it may very well be detrimental. Given the potential for late cardiovascular mortality, and the known increase in the risk of arm oedema after the combination of axillary surgery and radiotherapy,2Larson D Weinstein M Goldberg I et al.Edema of the arm as a function of the extent of axillary surgery in patients with stage I-II carcinoma of the breast treated with primary radiotherapy.Int J Radiat Oncol Biol Phys. 1986; 12: 1575-1582Summary Full Text PDF PubMed Scopus (335) Google Scholar it would seem prudent to continue to treat patients with either of the current standard options breast conserving surgery combined with axillary dissection and breast radiotherapy, or modified radical mastectomy alone." @default.
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• W2088894222 date "2000-10-01" @default.
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• W2088894222 title "Breast cancer survival advantage with radiotherapy" @default.
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• W2088894222 doi "https://doi.org/10.1016/s0140-6736(00)02803-8" @default.
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