Toxicity at three years with and without irradiation of the internal mammary and medial supraclavicular lymph node chain in stage I to III breast cancer (EORTC trial 22922/10925)

Abstract

Introduction. The EORTC 22922/10925 trial investigated the potential survival benefi t and toxicity of elective irradiation of the internal mammary and medial supraclavicular (IM-MS) nodes Accrual completed in January 2004 and fi rst results are expected in 2012. We present the toxicity reported until year 3 after treatment. Patients and methods. At each visit, toxicity was reported but severity was not graded routinely. Toxicity rates and performance status (PS) changes at three years were compared by χ 2 tests and logistic regression models in all the 3 866 of 4 004 patients eligible to the trial who received the allocated treatment. Results. Only lung (fi brosis; dyspnoea; pneumonitis; any lung toxicities) (4.3% vs. 1.3%; p Ͻ 0.0001) but not cardiac toxicity (0.3% vs. 0.4%; p ϭ 0.55) signifi cantly increased with IM-MS treatment. No signifi cant worsening of the PS was observed (p ϭ 0.79), suggesting that treatment-related toxicity does not impair patient's daily activities. Conclusions. IM-MS irradiation seems well tolerated and does not signifi cantly impair WHO PS at three years. A follow-up period of at least 10 years is needed to determine whether cardiac toxicity is increased after radiotherapy.

Internal Mammary and Medial Supraclavicular Irradiation in Breast Cancer

“…No significant difference was observed between the two study groups with respect to other late toxic effects or performance status. As compared with the previous 3-year morbidity report, 17 we found an increase in the risk of pulmonary fibrosis (from 0.9% to 1.7% in the control group and from 2.8% to 4.4% in the nodal-irradiation group). A total of 191 second cancers were diagnosed in the nodal-irradiation group and 222 were diagnosed in the control group.…”

“…As compared with the previous 3-year morbidity report, 17 we found only a slight increase in the risk of pulmonary fibrosis. These results are consistent with the results of studies of late pulmonary disease after radiation therapy for breast cancer.…”

“…34 We found a low rate of heart disease and death from heart disease after 10.9 years of follow-up, as has been reported before. 17,34 However, Darby et al found a dose-dependent increased risk of late ischemic heart disease associated with radiotherapy for cancer of the left breast. 28 Cardiac disease after radiation therapy might have onset early after treatment.…”

“…Details about the study population, radiation techniques, quality-assurance program, and toxic effects after 3 years of follow-up have been published previously. [14][15][16][17] We report here the final analysis of the primary and secondary end points, after a median follow-up of 10.9 years. Longterm analyses are planned after a median followup of 15 and 20 years.…”

Unintended irradiation of internal mammary chain – Is that enough?

“…Skin toxicity, 20 however, has no impact on survival but has an influence on cosmesis, especially at the areas of potential field overlapping. There is conflicting data in the literature regarding the adverse effects of IMC irradiation [21][22][23] and several techniques were developed, such as the partially extended tangent fields 10 and irradiation during inspiration, 24 in the pursuit of a more suitable therapeutic profile, with higher IMC coverage and decreased irradiation of adjacent organs.…”