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Previous Volume 337:956-962 October 2, 1997 Number 14 Next

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ABSTRACT

Background Radiotherapy after mastectomy to treat early breast cancer has been known since the 1940s to reduce rates of local relapse. However, the routine use of postoperative radiotherapy began to decline in the 1980s because it failed to improve overall survival. We prospectively tested the efficacy of combining radiotherapy with chemotherapy.

Methods From 1978 through 1986, 318 premenopausal women with node-positive breast cancer were randomly assigned, after modified radical mastectomy, to receive chemotherapy plus radiotherapy or chemotherapy alone. Radiotherapy was given to the chest wall and locoregional lymph nodes between the fourth and fifth cycles of cyclophosphamide, methotrexate, and fluorouracil.

Results After 15 years of follow-up, the women assigned to chemotherapy plus radiotherapy had a 33 percent reduction in the rate of recurrence (relative risk, 0.67; 95 percent confidence interval, 0.50 to 0.90) and a 29 percent reduction in mortality from breast cancer (relative risk, 0.71; 95 percent confidence interval, 0.51 to 0.99), as compared with the women treated with chemotherapy alone.

Conclusions Radiotherapy combined with chemotherapy after modified radical mastectomy decreases rates of locoregional and systemic relapse and reduces mortality from breast cancer.

Source Information

From the Departments of Medical Oncology (J.R., I.H.P., M.A.K., C.M.L.C.) and Radiation Oncology (S.M.J., V.E.B., M.P., I.A.O.), the Cancer Control Research Unit (N.L.), and the Cancer Control Strategy Process (A.J.C.), British Columbia Cancer Agency, Vancouver; the Department of Health Care and Epidemiology, University of British Columbia, Vancouver (J.J.S.); the Health Research Centre, St. Paul's Hospital, Vancouver (J.J.S.); and the Department of Medical Oncology, British Columbia Cancer Agency, Victoria (K.S.W.) — all in British Columbia, Canada.

Address reprint requests to Dr. Ragaz at Medical Oncology, British Columbia Cancer Agency, 600 W. 10th Ave., Vancouver, BC V5Z 4E6, Canada.

Full Text of this Article

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Extract | Full Text  
N Engl J Med 1998; 338:329-333, Jan 29, 1998. Correspondence

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• van Dongen, J. A., Voogd, A. C., Fentiman, I. S., Legrand, C., Sylvester, R. J., Tong, D., van der Schueren, E., Helle, P. A., van Zijl, K., Bartelink, H. (2000). Long-Term Results of a Randomized Trial Comparing Breast-Conserving Therapy With Mastectomy: European Organization for Research and Treatment of Cancer 10801 Trial. JNCI J Natl Cancer Inst 92: 1143-1150 [Abstract] [Full Text]  
• McMasters, K. M., Tuttle, T. M., Carlson, D. J., Brown, C. M., Noyes, R. D., Glaser, R. L., Vennekotter, D. J., Turk, P. S., Tate, P. S., Sardi, A., Cerrito, P. B., Edwards, M. J. (2000). Sentinel Lymph Node Biopsy for Breast Cancer: A Suitable Alternative to Routine Axillary Dissection in Multi-Institutional Practice When Optimal Technique Is Used. JCO 18: 2560-2566 [Abstract] [Full Text]