Benefit vs Harm of Internal Mammary Node Irradiation for Node-Positive Breast Cancer
Mené entre 1996 et 2004 sur 4 004 patientes atteintes d'un cancer du sein de stade I-III (durée médiane de suivi : 15,7 ans), cet essai randomisé international de phase III évalue les effets secondaires tardifs après irradiation des ganglions lymphatiques mammaires internes et sus-claviculaires médians
There has been ongoing debate for decades regarding adjuvant regional nodal irradiation for axillary node-positive breast cancer patients and in particular about whether the relative benefit of targeting the internal mammary nodes (IMN) as part of this treatment offsets its potential harms. The publication from Poortman et al. In this issue of the Journal that reports side effects 15 year after randomization to regional nodal irradiation with IMN versus not on the large EORTC 22922/ 10925 trial provides valuable long-term data to address this. At 15 years of follow up, those randomly assigned to IMN irradiation had a 2.7% and 2.8% higher cumulative incidence of any cardiac disease and clinical evidence of lung fibrosis, respectively. Most morbidity was grade 1 and there was no statistically significant difference in the incidence of grade 2 or higher cardiac or pulmonary toxicity. There was no difference in cardiac toxicity incidence between right versus left sided breast cancer nor in the incidence of second malignancies, contralateral breast cancer or cardiovascular deaths with IMN radiation.
Journal of the National Cancer Institute , éditorial en libre accès, 2020