SUPREMO S elective U se of P ostoperative R adiotherapy aft E r M astect O my MRC SUPREMO (BIG 2-04) S elective U se of P ostoperative R adiotherapy aft E r M astect O my Phase III randomised trial of chest wall RT in intermediate- risk breast cancer Kunkler I, Canney P, Price A,Prescott R, Hophood P,Dixon J, Sainsbury R,Aird E, Thomas G,Bowman A,Thomas J, Bartlett J,Dunlop J, Denvir M,McDonagh T,Russell N
Trials of PMRT in premen1-3 N+ + adjuvant CMFchemo (Fowble,1999) Trial No Redn LRR OS % C OS% C+RT P value Int (yr) B.C 183 23% 48 64 0.06 15act Den’k pre 1061 23% 54 62 - 10act Glas pre 141 NS 84 78 .40 5act Dana 83 3% 85 77 >.05 4.4me
Effects of RT on breast cancer mortality and all cause mortality after breast conserving / mastectomy and axillary clearance (EBCTCG; Lancet 2005;366:2087-2106
Oxford overview 2006; RT trials and breast cancer mortality at 20 yr, mastectomy & axillary clearance by nodal status Breast ca mortality (%) Breast ca mortality(%) 20 yr gain/loss(%) Path nodal status No RT RT pNO 28.7 30.2 -1.6 NS pN1-3 54.2 47.7 +6.4 2p=0.002 pN =/>4N+ 81.5 70.8 +10.7 2p=0.0008
pT1, pN1, M0 or pT2, pN0-1 M0 histologically confirmed invasive breast cancer.
Unifocal invasive breast cancer or multifocal breast cancer if at least a 2cm focus of invasive breast cancer
Fit for adjuvant chemotherapy (if indicated), adjuvant endocrine therapy (if indicated) and postoperative irradiation
Undergone simple mastectomy (with minimum of 1mm clear margin) and an axillary staging procedure
If axillary node clearance node positive (1-3 positive nodes) then an axillary node clearance (minimum of 10 nodes removed) should have been performed.
Axillary node negative status can be determined on the basis of either axillary node clearance, or axillary node sampling or sentinel node biopsy T2NO tumours are eligible with grade III histology and/or lymphovascular invasion