THE OHIO STATE UNIVERSITY SCHOOL OF HEALTH AND REHABILITATION SCIENCES

DIVISION OF RADIOLOGIC SCIENCES AND THERAPY (THERAPY)

Annotated Bibliography
Twenty-Year Follow-up of a Randomized Trial Comparing Total Mastectomy, Lumpectomy,
and Lumpectomy plus Irradiation for the Treatment of Invasive Breast Cancer

Impact of a Higher Radiation Dose on Local Control and Survival in Breast-Conserving Therapy
of Early Breast Cancer: 10-Year Results of the Randomized Boost Versus No Boost

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 randomized trials

Jackson Baumgartner
4/22/2017
Fisher B, Anderson S, Bryant J, et al. Twenty-Year Follow-up of a Randomized Trial Comparing
Total Mastectomy, Lumpectomy, and Lumpectomy plus Irradiation for the Treatment of
Invasive Breast Cancer. New England Journal of Medicine. 2002;347(16):1233-1241.
doi:10.1056/nejmoa022152.

This is a randomized study comparing total mastectomy, lumpectomy, and lumpectomy

plus Irradiation for the treatment of invasive breast cancer. Study involved a total of 1851
women randomly assigned (which makes this a true experiment) to the three different treatments.
Cohorts were evaluated after 20 years and all reported P values were based on a two sided test.
P less than or equal to 0.05 were considered statistically significant. The results stated that there
were no significant differences in overall survival among women undergoing mastectomy versus
lumpectomy with or without postoperative breast irradiation. However, the research found that
there was statistically significant evidence suggesting that postoperative irradiation reduced the
risk of ipsilateral recurrence, independent of nodal status. Overall, this was a good study
because they randomly selected and assigned patients and they tested for statistical significance.
However, I would recommend that they use more up-to-date meta-analysis to compare their
conclusions to (the researchers compared their results with a 1995 meta-analysis). Also,
repeating the tests with more patients would improve the validity of the results. Overall, this is a
very reliable test, since it can be reproduced, and the measurements are reliable. If these
findings are true then it would impact the way that the patient’s treatment is given following a
surgery. But this does indicate that most patients should be getting some kind of irradiation
following their operations in order to reduce the chance of local recurrence.

Bartelink H, Horiot J-C, Poortmans PM, et al. Impact of a Higher Radiation Dose on Local
Control and Survival in Breast-Conserving Therapy of Early Breast Cancer: 10-Year
Results of the Randomized Boost Versus No Boost EORTC 22881-10882 Trial. Journal
of Clinical Oncology. 2007;25(22):3259-3265. doi:10.1200/jco.2007.11.4991.

This was a randomly assigned (therefore a true experiment) trial designed to discover the
long term impact of a boost radiation treatment of 1600 cGy on local control, fibrosis, and
overall survival for patients with a low stage (I & II) breast cancer who underwent breast
conservation surgery. A total of 5,318 patients were randomly selected and 2,661 of them were
randomly assigned a boost treatment of 1600 cGy. All patients were followed up with in a
median time frame of 10.8 years. The results of the study suggested that local recurrence was
reduced from 10.2% to 6.2% between patients who did not receive a boost and those who did
(respectively). The researchers concluded that a boost dose of 1600 cGy led to improved local
control in all age groups but no difference in survival. This was a good study because their
patients were randomly assigned and they had many participants (even more than the first study)
which help to improve the external validity of the results. This is reliable because it can be
reproduced and the measurements are accurate. This is relevant to our clinical setting because it
suggests that it is beneficial for the patient to receive a boost and therefore most patients should
receive one, unless the physician decides otherwise for various reasons. Between all of these
studies, the recurring conclusion is that most patients should receive postoperative irradiation
following a breast conservation surgery and a boost in order to control local recurrence, and
even to help improve survival rates (as the meta-analysis suggested).

Housri N, Haffty B. 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 randomized trials. Breast Diseases: A Year Book Quarterly.
2012;23(3):266-267. doi:10.1016/j.breastdis.2012.06.011.

This was a meta-analysis using data from 10,801 women from 17 different randomized
trials researching the benefit of irradiation after breast conservation surgery. Studies that were
eligible for the meta-analysis were those beginning before the year 2000. The researchers found
that irradiation after BCS reduced the 10-year risk of any first recurrences and reduced the 15-
year risk of breast cancer death. This was interpreted using a significance test. Their final
conclusion was that postoperative irradiation halves the rate of recurrence and reduces the
breast cancer death rate by a sixth. This is a great study because the studies it drew from were
all reliable and randomized (therefore they are all true experiments), the researchers used very
up-to-date information (no studies conducted before 2000 were eligible) and it is a meta-analysis
which yields the highest level of scientific evidence possible. This is relevant to our clinical
practice because it means that just about every patient should be receiving postoperative
irradiation following a breast conservation surgery in order to decrease their chances of local
recurrence and improving their life expectancy.
 Work’s Cited

Fisher B, Anderson S, Bryant J, et al. Twenty-Year Follow-up of a Randomized Trial Comparing

Total Mastectomy, Lumpectomy, and Lumpectomy plus Irradiation for the Treatment of
Invasive Breast Cancer. New England Journal of Medicine. 2002;347(16):1233-1241.
doi:10.1056/nejmoa022152.

Bartelink H, Horiot J-C, Poortmans PM, et al. Impact of a Higher Radiation Dose on Local
Control and Survival in Breast-Conserving Therapy of Early Breast Cancer: 10-Year
Results of the Randomized Boost Versus No Boost EORTC 22881-10882 Trial. Journal
of Clinical Oncology. 2007;25(22):3259-3265. doi:10.1200/jco.2007.11.4991.

Housri N, Haffty B. 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 randomized trials. Breast Diseases: A Year Book Quarterly.
2012;23(3):266-267. doi:10.1016/j.breastdis.2012.06.011.