Postoperative Radiotherapy for Breast Cancer: Growing Evidence for an Impact on Survival
Notice bibliographique
Résumé
Postoperative radiotherapy for breast cancer is known to substantially reduce the risk of locoregional recurrence, both when given after mastectomy and after breast-conserving surgery. Recent reports [cited below] suggest that radiotherapy following mastectomy may also have a beneficial impact on survival, and the article by Vinh-Hung et al. (1), published in this issue of the Journal, further suggests that radiotherapy given after breast-conserving surgery improves survival. Three randomized clinical trials (2–4) of postmastectomy radiotherapy, conducted in Canada and Denmark, have shown a 9%–10% improvement in overall survival at 10 years for patients that received radiotherapy compared with patients who did not receive radiotherapy. These results contrast with those of a patient-based meta-analysis of randomized clinical trials (5) in which radiotherapy was shown to be associated with a reduced risk of dying of breast cancer; however, this reduced risk was offset by increased mortality from vascular causes. There are several possible explanations for this apparent discrepancy. Many of the trials included in the patient-based meta-analysis (5) were initiated a long time ago, and these trials were often small and involved radiotherapy techniques and fractionation schedules that resulted in higher doses to the heart than are obtained with modern radiotherapy techniques. In a reanalysis of data from these trials, a substantial reduction was found in the risk of mortality associated with radiotherapy of 12.4% (P<.001) when only recent trials were included (6). In addition, patients treated in the Canadian and Danish trials (2–4) received adjuvant chemotherapy and/or tamoxifen (i.e., systemic therapy) in conjunction with radiotherapy. Hence, if the burden of distant micrometastases can be reduced by systemic therapy, then radiotherapy given to locoregional sites might prevent secondary dissemination, thus being potentially curative. This hypothesis is supported by the results of a meta-analysis of randomized clinical trials of adjuvant radiotherapy (7) in which patients also received systemic therapy. In these trials, adjuvant radiotherapy statistically significantly reduced the risk of mortality (odds ratio = 0.83, 95% confidence interval [CI] = 0.74 to 0.94; P = .04). These results have led to the general acceptance that radiotherapy given after mastectomy to patients at moderate or high risk of dying from breast cancer has favorable effects on survival.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,025 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,001 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,002 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,014 | 0,010 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,009 | 0,004 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».