the world’s breast cancer trialists have shared their data every 5 years
DESCRIPTION
Meta-analysis of trials of radiotherapy in DCIS Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). The world’s breast cancer trialists have shared their data every 5 years 1985, 1990, 1995, 2000, 2005/6 Many MODERATE gains in long-term survival have been identified - PowerPoint PPT PresentationTRANSCRIPT
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Meta-analysis of trials of radiotherapy in DCIS
Early Breast Cancer Trialists’ Collaborative Group (EBCTCG)
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EBCTCG 5th Cycle 2
The world’s breast cancer trialists have shared their data every 5 years
1985, 1990, 1995, 2000, 2005/6
Many MODERATE gains in long-term survival have been identified
Together MODERATE gains from various treatment improvements (and a moderate contribution from
breast screening) have almost halved UK/US breast cancer mortality at ages 35-69
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3EBCTCG 5th Cycle
#
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EBCTCG 5th Cycle 4
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EBCTCG 5th Cycle 5
EBCTCG 5th Cycle
• Trials starting before 1 Jan 2000• Events up to 30 Sept 2006• Included trials of BCS±RT in DCIS for the
first time– ie, trials of RT versus the same management
but without RT
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EBCTCG 5th Cycle 6
Randomized trials of BCS±RT in DCIS
Study Entry Women random-
ised
Median follow-
up Surgery*
Negative margins required
%
with boost
Data available:
NSABP B-17 1985-90 818 16.5 y WLE (37% ad) Yes
9%
EORTC 10853 1986-96 1010 10.4 y WLE (20% ad) Yes
5%
SweDCIS 1987-99 1067 8.4 y Sect res (17% ad) No
2%
UK/ANZ DCIS† 1990-98 1030 4.8 y WLE (No ad) Yes NR‡
Data unavailable:§
RTOG 9804 1999-06 636 N/A WLE (No ad) Yes NR‡
* WLE: wide local excision; ad: axillary dissection; Sect res: sector resection † 2x2 factorial design: ±RT±Tam ‡ Boost not recommended § Some patients still taking tamoxifen Median follow-up for all trials with data available: 8.9 y
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EBCTCG 5th Cycle 7
Randomized trials of BCS±RT in DCIS
Eligibility of randomized patients for EBCTCG meta-analysis
Eligibility status NSABP B-17 EORTC
10853 Swedish BCCG UK/ANZ Total
Eligible* 798 918 1,011 1,002 3,729
Ineligible† 20 92 56 28 196
Total 818 1,010 1,067 1,030 3,925
*Taking into account all information available to EBCTCG †Benign lesion only; microinvasion, invasion, Paget's disease, or other cancer present at randomization; or other study-specific eligibility violation
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EBCTCG 5th Cycle 8
Randomized trials of BCS±RT in DCIS
Distribution of women by calendar year of randomisation
Calendar year NSABP B-17 EORTC
10853 Swedish BCCG
UK/ANZ Total
1985-89 71% 17% 6% - 21%
1990-94 29% 60% 51% 46% 47%
1995-99 - 23% 43% 54% 32%
Total 100% 100% 100% 100% 100%
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EBCTCG 5th Cycle 9
Main outcome analysed:
• Ipsilateral breast recurrence
(either recurrence of CIS or occurrence of invasive cancer)
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EBCTCG 5th Cycle 10
DCIS: BCS + RT vs. BCSIps. BREAST RECURRENCE (CIS & Inv)
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EBCTCG 5th Cycle 11
DCIS: BCS + RT vs. BCSIps. BREAST RECURRENCE (CIS & Inv)
3729 women
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DCIS: BCS + RT vs. BCS
Ips. BREAST RECURRENCE (CIS & Inv)
Ratio of annual event rates by patient and tumour characteristics
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EBCTCG 5th Cycle 13
DCIS: BCS + RT vs. BCSIps. BREAST RECURRENCE (CIS & Inv)
Age at diagnosis
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EBCTCG 5th Cycle 14
DCIS: BCS + RT vs. BCSIps. BREAST RECURRENCE (CIS & Inv)
Extent of breast-conserving surgery
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EBCTCG 5th Cycle 15
DCIS: BCS + RT vs. BCSIps. BREAST RECURRENCE (CIS & Inv)
Use of tamoxifen (in both treatment arms)
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EBCTCG 5th Cycle 16
DCIS: BCS + RT vs. BCSIps. BREAST RECURRENCE (CIS & Inv)
Method of DCIS detection
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EBCTCG 5th Cycle 17
DCIS: BCS + RT vs. BCSIps. BREAST RECURRENCE (CIS & Inv)
Margin status
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EBCTCG 5th Cycle 18
DCIS: BCS + RT vs. BCSIps. BREAST RECURRENCE (CIS & Inv)
Focality
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EBCTCG 5th Cycle 19
DCIS: BCS + RT vs. BCS Ips. BREAST RECURRENCE (CIS & Inv)
Histological grade
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EBCTCG 5th Cycle 20
DCIS: BCS + RT vs. BCS Ips. BREAST RECURRENCE (CIS & Inv)
Nuclear grade
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EBCTCG 5th Cycle 21
DCIS: BCS + RT vs. BCSIps. BREAST RECURRENCE (CIS & Inv)
Comedonecrosis
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EBCTCG 5th Cycle 22
DCIS: BCS + RT vs. BCSIps. BREAST RECURRENCE (CIS & Inv)
Architecture
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EBCTCG 5th Cycle 23
DCIS: BCS + RT vs. BCSIps. BREAST RECURRENCE (CIS & Inv)
Clinical primary tumour size
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EBCTCG 5th Cycle 24
DCIS: BCS + RT vs. BCSIps. BREAST RECURRENCE (CIS & Inv)
Pathological primary tumour size
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EBCTCG 5th Cycle 25
DCIS: BCS + RT vs. BCSIps. BREAST RECURRENCE (CIS & Inv)
among women with 1-20 mm tumours and negative margin status
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DCIS: BCS + RT vs. BCSIps. BREAST RECURRENCE (CIS & Inv)
Ratio of annual event rates by age and histological grade
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EBCTCG 5th Cycle 27
DCIS: BCS + RT vs. BCSIps. BREAST RECURRENCE (CIS & Inv)
Ratio of annual event rates by age and comedonecrosis
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EBCTCG 5th Cycle 28
DCIS: BCS + RT vs. BCS3729 women
Contralateral breast events Regional or distant events
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EBCTCG 5th Cycle 29
DCIS: BCS + RT vs. BCS3729 women
Any breast event *
*ie ipsilateral or contralateral DCIS, ipsilateral or contralateral invasive cancer, regional or distant metastasis, or death certified as due to breast cancer
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EBCTCG 5th Cycle 30
DCIS: BCS + RT vs. BCS3729 women
Mortality with a breast event Mortality without a breast event Mortality from all causes
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EBCTCG 5th Cycle 31
DCIS: BCS + RT vs. BCS3729 women
Heart disease mortality Non-breast primary cancer incidence
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EBCTCG analysis of radiotherapy in DCISConclusions
• In these trials, radiotherapy halved the recurrence rate of either DCIS or invasive cancer in the ipsilateral breast. After 5 years the absolute gain was about 10% (18% vs. 8%) and after 10 years it was about 15% (28% vs. 13%).
• The absolute gain in ‘low risk’ women was as large as in other other women.
• The proportional reduction in the ipsilateral recurrence rate was greater in women aged 50+ years than in younger women.
• Radiotherapy had no significant effect on mortality from breast cancer, at least to year 10.
• In these data, radiotherapy had no significant adverse effect on cancers other than breast cancer, or on mortality from non-breast cancer causes, including heart disease.
EBCTCG 5th Cycle