Avtor/Urednik		Darby, S; McGale, P; Correa, C; Čufer, T
Naslov		Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials
Tip		članek
Vir		Lancet
Vol. in št.		Letnik 378, št. 9804
Leto izdaje		2011
Obseg		str. 1707-16
Jezik		eng
Abstrakt		Background: After breast-conserving surgery, radiotherapy reduces recurrence and breast cancer death, but it may do so more for some groups of women than for others. We describe the absolute magnitude of these reductions according to various prognostic and other patient characteristics, and relate the absolute reduction in 15-year risk of breast cancer death to the absolute reduction in 10-year recurrence risk. Methods: We undertook a meta-analysis of individual patient data for 10,801 women in 17 randomised trials of radiotherapy versus no radiotherapy after breast-conserving surgery, 8337 of whom had pathologically confirmed node-negative (pN0) or node-positive (pN+) disease. Findings: Overall, radiotherapy reduced the 10-year risk of any (ie, locoregional or distant) first recurrence from 35-0% to 19-3% (absolute reduction 15-7%, 95% CI 13-7-17-7, 2p<0-00001) and reduced the 15-year risk of breast cancer death from 25-2% to 21-4% (absolute reduction 3-8%, 1-6-6-0, 2p=0-00005). In women with pN0 disease (n=7287), radiotherapy reduced these risks from 31-0% to 15-6% (absolute recurrence reduction 15-4%, 13-2-17-6, 2p<0-00001) and from 20-5% to 17-2% (absolute mortality reduction 3-3%, 0-8-5-8, 2p=0-005), respectively. In these women with pN0 disease, the absolute recurrence reduction varied according to age, grade, oestrogen-receptor status, tamoxifen use, and extent of surgery, and these characteristics were used to predict large (?20%), intermediate (10-19%), or lower (<10%) absolute reductions in the 10-year recurrence risk. Absolute reductions in 15-year risk of breast cancer death in these three prediction categories were 7-8% (95% CI 3-1-12-5), 1-1% (-2-0 to 4-2), and 0-1% (-7-5 to 7-7) respectively (trend in absolute mortality reduction 2p=0-03). (Abstract truncated at 2000 characters)
Deskriptorji		BREAST NEOPLASMS MASTECTOMY NEOPLASM RECURRENCE, LOCAL RISK FACTORS NEOPLASM STAGING RECEPTORS, ESTROGEN TAMOXIFEN SURVIVAL ANALYSIS META-ANALYSIS RANDOMIZED CONTROLLED TRIALS