Will the recent publication of the MA.20 and EORTC 22922 studies in NEJM, showing no survival advantage from regional nodal irradiation in early-stage breast cancer patient following surgery, change your standard of care for these patients?
Two major landmark studies recently published simultaneously in the New England Journal of Medicine, Volume 373, 2015 (NCIC MA.20 study by Whelan et al. and the European Organization for Research and Treatment of Cancer (EORTC) 22922-10925 study by Poortmans et al.) will have a significant impact on...
My impression from talking to colleagues is that the publication of 10-year data from these nodal trials has generated more division and controversy than ever before. I offer my humble opinion of the evolution of practice, these new trial data, and my future clinical decisions:
1) The past: Prior to ...
The recently published EORTC-22922 and MA.20 trials showed regional node irradiation (RNI, defined as medial supraclavicular (SCV) and internal mammary nodes (IMN)) improved disease free survival (DFS). However, how much outcome benefits came from SCV versus IMN treatment? Since RNI added 3-5% impro...
Re the recently published EORTC-22922 and MA.20 trials
Do we ignore the 3-4% improvement in dDFS and abandon RNI for women with 1-3+ nodes?
Do we offer RNI to everyone with node (+) disease?
---------------
I would like to add a comment re these important studies as they are creating some controversy am...
In my opinion, the increased risk of severe side effects when treating RNI/IM fields (such as pneumonitis and cardiac events) is much higher than the 1.6 percent improvement in disease free survival noted on MA.20. The proper endpoint for breast cancer should be overall survival (just as in NSABP 06...