IN THIS ISSUE

Extract

Survival and Postmastectomy Adjuvant Radiation Therapy

To determine whether postmastectomy radiation therapy reduces mortality among women with operable breast cancer, Gebski et al. (p. 26 ) reanalyzed results from 36 clinical trials, in which giving radiation therapy was the only difference between groups in each trial. They found a 2.9% absolute increase in 5-year survival and a 6.4% absolute increase in 10-year survival associated with radiation therapy, compared with no radiation therapy, among trials that used a biologically equivalent dose (BED) of 40–60 Gy in 2 Gy fractions with an appropriate target volume. No statistically significant change in survival was associated with radiation therapy delivered in an inadequate or excessive dose or to an inappropriate target volume. They conclude that adjuvant radiation therapy with an optimal BED was associated with improved survival for up to 10 years.

In an accompanying editorial, Prosnitz and Marks (p. 3 ) note that the quality of postmastectomy radiation therapy is important for outcome and that evidence is now strong for use of radiation therapy after both mastectomy and lumpectomy. They note that emphasis should shift to developing better selection criteria for patients who should receive postsurgical radiation therapy.