Very misleading Title on Nodal irradiation for Breast Cancer

[RadOncDoc21]

Had a patient show me this article today, I had to convince her that she needed nodal radiation (5+ LN). She did have a point in that the title stated that she doesn't need it!

The article does say 4+ still needs nodal RT but its hidden in the text. Didn't the Meta-analysis show OS benefit in all N+ patients? I thought the problem with MA20 was that long-term data was the issue.


http://www.medscape.com/viewarticle/848474?src=wnl_edit_tp10&uac=146618HN&impID=805708&faf=1

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[medgator]

https://www.ncbi.nlm.nih.gov/pubmed/17306393?dopt=Abstract

The danish studies did nodal xrt in everyone and demonstrated an OS benefit

 

[RadOncDoc21]

Only in breast cancer can we have so much data about nothing! I cringe whenever I think about the next "big" trial for breast cancer.

 

[hot sauce]

If a patient asks specifically about survival I would say that the current studies did not show a statistically significant survival benefit to treating nodes compared to just tangents (although EORTC OS p = 0.06). However, other outcomes such as disease free survival, isolated locoregional disease free survival, and distant disease free survival were significantly different in MA.20; additionally, EORTC showed a disease specific survival benefit. These are important outcomes in my opinion and I think most women would want the benefit of being more likely to be alive without breast cancer in 10 years. Of course, you do have to balance with the (slightly) higher toxicity.

 

[RadOncDoc21]

Do we just not even bring up the EBCTCG meta-analysis anymore? Granted, the trials were old but we're talking about an extremely large data set and long-term outcomes.

 

[RustBeltOnc]

If a patient asks specifically about survival I would say that the current studies did not show a statistically significant survival benefit to treating nodes compared to just tangents (although EORTC OS p = 0.06). However, other outcomes such as disease free survival, isolated locoregional disease free survival, and distant disease free survival were significantly different in MA.20; additionally, EORTC showed a disease specific survival benefit. These are important outcomes in my opinion and I think most women would want the benefit of being more likely to be alive without breast cancer in 10 years. Of course, you do have to balance with the (slightly) higher toxicity.

We have this discussion in med onc all the time. Most pts under 70 without significant co morbids care about this; many of the older ones don't. I actually find it very satisfying when a patient makes an informed choice.