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Selective Use Of Postoperative Radiotherapy AftEr MastectOmy

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  SUPREMO     S elective U se of P ostoperative R adiotherapy aft E r M astect O my                                     MRC SUPREMO (BIG 2-04)     S elective U se of P ostoperative R adiotherapy aft E r M astect O my Phase III randomised trial of chest wall RT in intermediate- risk breast cancer Kunkler I, Canney P, Price A,Prescott R, Hophood P,Dixon J, Sainsbury R,Aird E, Thomas G,Bowman A,Thomas J, Bartlett J,Dunlop J, Denvir M,McDonagh T,Russell N  
Background: Trials of postmastectomy RT ,[object Object],[object Object],[object Object],[object Object]
 
Trials of PMRT in premen1-3 N+ + adjuvant CMFchemo (Fowble,1999) Trial No Redn LRR OS % C OS% C+RT P value Int (yr) B.C 183 23% 48 64 0.06 15act Den’k pre 1061 23% 54 62 - 10act Glas pre 141 NS 84 78 .40 5act Dana 83 3% 85 77 >.05 4.4me
Whelan & Levine,JNCI Jan 2005 ,[object Object],[object Object],[object Object]
Effects of RT on breast cancer mortality and all cause mortality after breast conserving / mastectomy and axillary clearance (EBCTCG; Lancet 2005;366:2087-2106
Oxford overview 2006; RT trials and breast cancer mortality at 20 yr, mastectomy & axillary clearance by nodal status Breast ca mortality (%) Breast ca mortality(%) 20 yr gain/loss(%) Path nodal status No RT RT pNO 28.7 30.2 -1.6 NS pN1-3 54.2 47.7 +6.4 2p=0.002 pN =/>4N+ 81.5 70.8 +10.7 2p=0.0008
Interpretation of Overview of RT trials ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
PMRT 1-3 N+ with 8 or more nodes DBCG 82b,c trial Overgaard et al,Radiother Oncol,2007 RT No RT p value LRR 4% 27% <0.001 Overall survival 57% 48% 0.03
Whelan et al JCO 2000 2000;18:1220-29 0.73 - 1.38 1.00 5 YES 0.25 0.70 - 0.89 0.79 13 NO p 95% CI Odds ratio No of studies Anthracycline use
Overall and relapse free survival NEAT trial (Poole et al,NEJM,2006
Eligibility criteria ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Exclusion criteria ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Randomisation in SUPREMO Chest wall irradiation Vs No chest wall irradiation
Endpoints for SUPREMO : ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Powering of the trial ,[object Object],[object Object],[object Object]
Biological,cardiac, QL and health economic substudies
TRANS-SUPREMO ,[object Object]
Proteins which may affect local relapse ,[object Object],[object Object],[object Object],[object Object],[object Object]
Late cardiac morbidity ( EBCTCG,Lancet 2000;355:1757-1770) ,[object Object],[object Object],[object Object],[object Object],field Maximum Heart Distance (MHD) Heart contour Breast contour
SUPREMO collaboration 136 centres in 24 countries
Acknowledgements ,[object Object]

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Selective Use Of Postoperative Radiotherapy AftEr MastectOmy

  • 1.   SUPREMO     S elective U se of P ostoperative R adiotherapy aft E r M astect O my                                     MRC SUPREMO (BIG 2-04)     S elective U se of P ostoperative R adiotherapy aft E r M astect O my Phase III randomised trial of chest wall RT in intermediate- risk breast cancer Kunkler I, Canney P, Price A,Prescott R, Hophood P,Dixon J, Sainsbury R,Aird E, Thomas G,Bowman A,Thomas J, Bartlett J,Dunlop J, Denvir M,McDonagh T,Russell N  
  • 2.
  • 3.  
  • 4. Trials of PMRT in premen1-3 N+ + adjuvant CMFchemo (Fowble,1999) Trial No Redn LRR OS % C OS% C+RT P value Int (yr) B.C 183 23% 48 64 0.06 15act Den’k pre 1061 23% 54 62 - 10act Glas pre 141 NS 84 78 .40 5act Dana 83 3% 85 77 >.05 4.4me
  • 5.
  • 6. Effects of RT on breast cancer mortality and all cause mortality after breast conserving / mastectomy and axillary clearance (EBCTCG; Lancet 2005;366:2087-2106
  • 7. Oxford overview 2006; RT trials and breast cancer mortality at 20 yr, mastectomy & axillary clearance by nodal status Breast ca mortality (%) Breast ca mortality(%) 20 yr gain/loss(%) Path nodal status No RT RT pNO 28.7 30.2 -1.6 NS pN1-3 54.2 47.7 +6.4 2p=0.002 pN =/>4N+ 81.5 70.8 +10.7 2p=0.0008
  • 8.
  • 9. PMRT 1-3 N+ with 8 or more nodes DBCG 82b,c trial Overgaard et al,Radiother Oncol,2007 RT No RT p value LRR 4% 27% <0.001 Overall survival 57% 48% 0.03
  • 10. Whelan et al JCO 2000 2000;18:1220-29 0.73 - 1.38 1.00 5 YES 0.25 0.70 - 0.89 0.79 13 NO p 95% CI Odds ratio No of studies Anthracycline use
  • 11. Overall and relapse free survival NEAT trial (Poole et al,NEJM,2006
  • 12.
  • 13.
  • 14. Randomisation in SUPREMO Chest wall irradiation Vs No chest wall irradiation
  • 15.
  • 16.
  • 17. Biological,cardiac, QL and health economic substudies
  • 18.
  • 19.
  • 20.
  • 21. SUPREMO collaboration 136 centres in 24 countries
  • 22.