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Breast cancer
Benefits of locoregional iradiation added to whole breast iradiation

Ted Vandenberg, MD, FRCPC, Medical Oncologist and Breast Disease Site Council Director, London Regional Cancer Program; Professor, Department of Oncology, University of Western Ontario.

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TRIAL SUMMARY: Regional nodal irradiation improves survival for high-risk disease post breast-conserving surgery

 

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In Brief

Already known

  • Trials published in the 1990s from Scandinavia and British Columbia showed a reduced risk of recurrence and survival benefits for women treated with systemic therapy by adding locoregional radiation after mastectomy.

What this study showed

  • This study confirms the benefits of locoregional radiation in the era of more effective systemic therapies and extends the indications for treatment to women with 1–3 positive lymph nodes.
  • Even though women undergoing WBI receive treatment to the lower axilla, it confirms the additional benefit of aggressive locoregional radiation to this group.
  • Distant DFS is significantly improved with regional nodal irradiation and likely outweighs demonstrated toxicities of pneumonitis, lymphedema and altered cosmesis.

Next steps

  • Longer-term followup and further information on the impact of micrometastases are required.
  • A German trial is underway to validate the results of ACOSOG Z0011, which showed no difference in local control, distant metastases or survival for no further ALND vs completion ALND.
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