Partial-breast radiotherapy after breast conservation surgery for patients with early breast cancer (UK IMPORT LOW trial): 5-year results from a multicentre, randomised, controlled, phase 3, non-inferiority trial
Local cancer relapse risk after breast conservation surgery followed by radiotherapy has fallen sharply in many countries, and is influenced by patient age and clinicopathological factors. We hypothesise that partial-breast radiotherapy restricted to the vicinity of the original tumour in women at l...
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Published in | The Lancet (British edition) Vol. 390; no. 10099; pp. 1048 - 1060 |
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Main Authors | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
England
Elsevier Ltd
09.09.2017
Elsevier Limited Elsevier |
Subjects | |
Online Access | Get full text |
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Abstract | Local cancer relapse risk after breast conservation surgery followed by radiotherapy has fallen sharply in many countries, and is influenced by patient age and clinicopathological factors. We hypothesise that partial-breast radiotherapy restricted to the vicinity of the original tumour in women at lower than average risk of local relapse will improve the balance of beneficial versus adverse effects compared with whole-breast radiotherapy.
IMPORT LOW is a multicentre, randomised, controlled, phase 3, non-inferiority trial done in 30 radiotherapy centres in the UK. Women aged 50 years or older who had undergone breast-conserving surgery for unifocal invasive ductal adenocarcinoma of grade 1–3, with a tumour size of 3 cm or less (pT1–2), none to three positive axillary nodes (pN0–1), and minimum microscopic margins of non-cancerous tissue of 2 mm or more, were recruited. Patients were randomly assigned (1:1:1) to receive 40 Gy whole-breast radiotherapy (control), 36 Gy whole-breast radiotherapy and 40 Gy to the partial breast (reduced-dose group), or 40 Gy to the partial breast only (partial-breast group) in 15 daily treatment fractions. Computer-generated random permuted blocks (mixed sizes of six and nine) were used to assign patients to groups, stratifying patients by radiotherapy treatment centre. Patients and clinicians were not masked to treatment allocation. Field-in-field intensity-modulated radiotherapy was delivered using standard tangential beams that were simply reduced in length for the partial-breast group. The primary endpoint was ipsilateral local relapse (80% power to exclude a 2·5% increase [non-inferiority margin] at 5 years for each experimental group; non-inferiority was shown if the upper limit of the two-sided 95% CI for the local relapse hazard ratio [HR] was less than 2·03), analysed by intention to treat. Safety analyses were done in all patients for whom data was available (ie, a modified intention-to-treat population). This study is registered in the ISRCTN registry, number ISRCTN12852634.
Between May 3, 2007, and Oct 5, 2010, 2018 women were recruited. Two women withdrew consent for use of their data in the analysis. 674 patients were analysed in the whole-breast radiotherapy (control) group, 673 in the reduced-dose group, and 669 in the partial-breast group. Median follow-up was 72·2 months (IQR 61·7–83·2), and 5-year estimates of local relapse cumulative incidence were 1·1% (95% CI 0·5–2·3) of patients in the control group, 0·2% (0·02–1·2) in the reduced-dose group, and 0·5% (0·2–1·4) in the partial-breast group. Estimated 5-year absolute differences in local relapse compared with the control group were −0·73% (−0·99 to 0·22) for the reduced-dose and −0·38% (−0·84 to 0·90) for the partial-breast groups. Non-inferiority can be claimed for both reduced-dose and partial-breast radiotherapy, and was confirmed by the test against the critical HR being more than 2·03 (p=0·003 for the reduced-dose group and p=0·016 for the partial-breast group, compared with the whole-breast radiotherapy group). Photographic, patient, and clinical assessments recorded similar adverse effects after reduced-dose or partial-breast radiotherapy, including two patient domains achieving statistically significantly lower adverse effects (change in breast appearance [p=0·007 for partial-breast] and breast harder or firmer [p=0·002 for reduced-dose and p<0·0001 for partial-breast]) compared with whole-breast radiotherapy.
We showed non-inferiority of partial-breast and reduced-dose radiotherapy compared with the standard whole-breast radiotherapy in terms of local relapse in a cohort of patients with early breast cancer, and equivalent or fewer late normal-tissue adverse effects were seen. This simple radiotherapy technique is implementable in radiotherapy centres worldwide.
Cancer Research UK. |
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AbstractList | Local cancer relapse risk after breast conservation surgery followed by radiotherapy has fallen sharply in many countries, and is influenced by patient age and clinicopathological factors. We hypothesise that partial-breast radiotherapy restricted to the vicinity of the original tumour in women at lower than average risk of local relapse will improve the balance of beneficial versus adverse effects compared with whole-breast radiotherapy.
IMPORT LOW is a multicentre, randomised, controlled, phase 3, non-inferiority trial done in 30 radiotherapy centres in the UK. Women aged 50 years or older who had undergone breast-conserving surgery for unifocal invasive ductal adenocarcinoma of grade 1-3, with a tumour size of 3 cm or less (pT1-2), none to three positive axillary nodes (pN0-1), and minimum microscopic margins of non-cancerous tissue of 2 mm or more, were recruited. Patients were randomly assigned (1:1:1) to receive 40 Gy whole-breast radiotherapy (control), 36 Gy whole-breast radiotherapy and 40 Gy to the partial breast (reduced-dose group), or 40 Gy to the partial breast only (partial-breast group) in 15 daily treatment fractions. Computer-generated random permuted blocks (mixed sizes of six and nine) were used to assign patients to groups, stratifying patients by radiotherapy treatment centre. Patients and clinicians were not masked to treatment allocation. Field-in-field intensity-modulated radiotherapy was delivered using standard tangential beams that were simply reduced in length for the partial-breast group. The primary endpoint was ipsilateral local relapse (80% power to exclude a 2·5% increase [non-inferiority margin] at 5 years for each experimental group; non-inferiority was shown if the upper limit of the two-sided 95% CI for the local relapse hazard ratio [HR] was less than 2·03), analysed by intention to treat. Safety analyses were done in all patients for whom data was available (ie, a modified intention-to-treat population). This study is registered in the ISRCTN registry, number ISRCTN12852634.
Between May 3, 2007, and Oct 5, 2010, 2018 women were recruited. Two women withdrew consent for use of their data in the analysis. 674 patients were analysed in the whole-breast radiotherapy (control) group, 673 in the reduced-dose group, and 669 in the partial-breast group. Median follow-up was 72·2 months (IQR 61·7-83·2), and 5-year estimates of local relapse cumulative incidence were 1·1% (95% CI 0·5-2·3) of patients in the control group, 0·2% (0·02-1·2) in the reduced-dose group, and 0·5% (0·2-1·4) in the partial-breast group. Estimated 5-year absolute differences in local relapse compared with the control group were -0·73% (-0·99 to 0·22) for the reduced-dose and -0·38% (-0·84 to 0·90) for the partial-breast groups. Non-inferiority can be claimed for both reduced-dose and partial-breast radiotherapy, and was confirmed by the test against the critical HR being more than 2·03 (p=0·003 for the reduced-dose group and p=0·016 for the partial-breast group, compared with the whole-breast radiotherapy group). Photographic, patient, and clinical assessments recorded similar adverse effects after reduced-dose or partial-breast radiotherapy, including two patient domains achieving statistically significantly lower adverse effects (change in breast appearance [p=0·007 for partial-breast] and breast harder or firmer [p=0·002 for reduced-dose and p<0·0001 for partial-breast]) compared with whole-breast radiotherapy.
We showed non-inferiority of partial-breast and reduced-dose radiotherapy compared with the standard whole-breast radiotherapy in terms of local relapse in a cohort of patients with early breast cancer, and equivalent or fewer late normal-tissue adverse effects were seen. This simple radiotherapy technique is implementable in radiotherapy centres worldwide.
Cancer Research UK. Local cancer relapse risk after breast conservation surgery followed by radiotherapy has fallen sharply in many countries, and is influenced by patient age and clinicopathological factors. We hypothesise that partial-breast radiotherapy restricted to the vicinity of the original tumour in women at lower than average risk of local relapse will improve the balance of beneficial versus adverse effects compared with whole-breast radiotherapy. IMPORT LOW is a multicentre, randomised, controlled, phase 3, non-inferiority trial done in 30 radiotherapy centres in the UK. Women aged 50 years or older who had undergone breast-conserving surgery for unifocal invasive ductal adenocarcinoma of grade 1–3, with a tumour size of 3 cm or less (pT1–2), none to three positive axillary nodes (pN0–1), and minimum microscopic margins of non-cancerous tissue of 2 mm or more, were recruited. Patients were randomly assigned (1:1:1) to receive 40 Gy whole-breast radiotherapy (control), 36 Gy whole-breast radiotherapy and 40 Gy to the partial breast (reduced-dose group), or 40 Gy to the partial breast only (partial-breast group) in 15 daily treatment fractions. Computer-generated random permuted blocks (mixed sizes of six and nine) were used to assign patients to groups, stratifying patients by radiotherapy treatment centre. Patients and clinicians were not masked to treatment allocation. Field-in-field intensity-modulated radiotherapy was delivered using standard tangential beams that were simply reduced in length for the partial-breast group. The primary endpoint was ipsilateral local relapse (80% power to exclude a 2·5% increase [non-inferiority margin] at 5 years for each experimental group; non-inferiority was shown if the upper limit of the two-sided 95% CI for the local relapse hazard ratio [HR] was less than 2·03), analysed by intention to treat. Safety analyses were done in all patients for whom data was available (ie, a modified intention-to-treat population). This study is registered in the ISRCTN registry, number ISRCTN12852634. Between May 3, 2007, and Oct 5, 2010, 2018 women were recruited. Two women withdrew consent for use of their data in the analysis. 674 patients were analysed in the whole-breast radiotherapy (control) group, 673 in the reduced-dose group, and 669 in the partial-breast group. Median follow-up was 72·2 months (IQR 61·7–83·2), and 5-year estimates of local relapse cumulative incidence were 1·1% (95% CI 0·5–2·3) of patients in the control group, 0·2% (0·02–1·2) in the reduced-dose group, and 0·5% (0·2–1·4) in the partial-breast group. Estimated 5-year absolute differences in local relapse compared with the control group were −0·73% (−0·99 to 0·22) for the reduced-dose and −0·38% (−0·84 to 0·90) for the partial-breast groups. Non-inferiority can be claimed for both reduced-dose and partial-breast radiotherapy, and was confirmed by the test against the critical HR being more than 2·03 (p=0·003 for the reduced-dose group and p=0·016 for the partial-breast group, compared with the whole-breast radiotherapy group). Photographic, patient, and clinical assessments recorded similar adverse effects after reduced-dose or partial-breast radiotherapy, including two patient domains achieving statistically significantly lower adverse effects (change in breast appearance [p=0·007 for partial-breast] and breast harder or firmer [p=0·002 for reduced-dose and p<0·0001 for partial-breast]) compared with whole-breast radiotherapy. We showed non-inferiority of partial-breast and reduced-dose radiotherapy compared with the standard whole-breast radiotherapy in terms of local relapse in a cohort of patients with early breast cancer, and equivalent or fewer late normal-tissue adverse effects were seen. This simple radiotherapy technique is implementable in radiotherapy centres worldwide. Cancer Research UK. A comprehensive literature search using PubMed and MEDLINE was done before the trial opened to identify all previous pathological and clinical breast radiotherapy studies investigating patterns of recurrence within the ipsilateral breast, and also to identify results of previous partial-breast radiotherapy studies. |
Author | Ciurlionis, Laura Ebbs, Stephen Winstanley, John Barber, Sarah Sculpher, Mark Venables, Karen Syndikus, Isabel Mills, Judith Barnett, Gillian Provenzano, Elena James, Hayley Poynter, Andrew Griffin, Clare L Evans, Philip Harnett, Adrian N Harris, Emma Kirk, Julie Wheatley, Duncan A Bliss, Peter Sydenham, Mark Wishart, Gordon Winship, Anna Hopwood, Penelope Jefford, Monica L Kaggwa, Ronald Yarnold, John R Eaton, David Emson, Marie A Haviland, Joanne S Mayles, Helen Rawlings, Christine Agrawal, Rajiv K Tsang, Yat M Kirwan, Cliona Kirby, Anna M Twyman, Nicola Dewar, John Thompson, Alastair Tutt, Andrew Brunt, Adrian M Ellis, Ian Wilcox, Maggie Al Sarakbi, Wail Donovan, Ellen M McIntyre, Anne Bliss, Judith M Sumo, Georges Chan, Charlie Bhattacharya, Indrani S Alhasso, Abdulla Sawyer, Elinor J Coles, Charlotte E Titley, Jenny |
AuthorAffiliation | e Department of Oncology, Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK f Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, UK b Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK a Department of Oncology, University of Cambridge, Cambridge, UK c Department of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK h Department of Radiation Oncology, Auckland City Hospital, Auckland, New Zealand p Department of Oncology, Royal Cornwall Hospitals NHS Trust, Truro, UK g Cancer Centre, University Hospitals of North Midlands and Keele University, Stoke-on-Trent, UK j Department of Health and Medical Sciences, University of Surrey, Guildford, UK m Department of Research Oncology, King's College London, London, UK n Cancer Centre, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, UK l Patient Advocate, London, UK o Department of Radiotherapy, Mount Vernon Cancer Centre Northwood, Northwood, UK i Depar |
AuthorAffiliation_xml | – name: d Department of Radiotherapy and Imaging, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK – name: i Department of Breast Surgery, Nuffield Health Cheltenham Hospital, Cheltenham, UK – name: p Department of Oncology, Royal Cornwall Hospitals NHS Trust, Truro, UK – name: k Department of Oncology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK – name: j Department of Health and Medical Sciences, University of Surrey, Guildford, UK – name: a Department of Oncology, University of Cambridge, Cambridge, UK – name: n Cancer Centre, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, UK – name: o Department of Radiotherapy, Mount Vernon Cancer Centre Northwood, Northwood, UK – name: g Cancer Centre, University Hospitals of North Midlands and Keele University, Stoke-on-Trent, UK – name: h Department of Radiation Oncology, Auckland City Hospital, Auckland, New Zealand – name: c Department of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK – name: b Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK – name: e Department of Oncology, Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK – name: f Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, UK – name: l Patient Advocate, London, UK – name: m Department of Research Oncology, King's College London, London, UK |
Author_xml | – sequence: 1 givenname: Charlotte E surname: Coles fullname: Coles, Charlotte E email: colesc@doctors.org.uk organization: Department of Oncology, University of Cambridge, Cambridge, UK – sequence: 2 givenname: Clare L surname: Griffin fullname: Griffin, Clare L organization: Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK – sequence: 3 givenname: Anna M surname: Kirby fullname: Kirby, Anna M organization: Department of Radiotherapy and Imaging, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK – sequence: 4 givenname: Jenny surname: Titley fullname: Titley, Jenny organization: Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK – sequence: 5 givenname: Rajiv K surname: Agrawal fullname: Agrawal, Rajiv K organization: Department of Oncology, Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK – sequence: 6 givenname: Abdulla surname: Alhasso fullname: Alhasso, Abdulla organization: Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, UK – sequence: 7 givenname: Indrani S surname: Bhattacharya fullname: Bhattacharya, Indrani S organization: Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK – sequence: 8 givenname: Adrian M surname: Brunt fullname: Brunt, Adrian M organization: Cancer Centre, University Hospitals of North Midlands and Keele University, Stoke-on-Trent, UK – sequence: 9 givenname: Laura surname: Ciurlionis fullname: Ciurlionis, Laura organization: Department of Radiation Oncology, Auckland City Hospital, Auckland, New Zealand – sequence: 10 givenname: Charlie surname: Chan fullname: Chan, Charlie organization: Department of Breast Surgery, Nuffield Health Cheltenham Hospital, Cheltenham, UK – sequence: 11 givenname: Ellen M surname: Donovan fullname: Donovan, Ellen M organization: Department of Health and Medical Sciences, University of Surrey, Guildford, UK – sequence: 12 givenname: Marie A surname: Emson fullname: Emson, Marie A organization: Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK – sequence: 13 givenname: Adrian N surname: Harnett fullname: Harnett, Adrian N organization: Department of Oncology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK – sequence: 14 givenname: Joanne S surname: Haviland fullname: Haviland, Joanne S organization: Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK – sequence: 15 givenname: Penelope surname: Hopwood fullname: Hopwood, Penelope organization: Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK – sequence: 16 givenname: Monica L surname: Jefford fullname: Jefford, Monica L organization: Patient Advocate, London, UK – sequence: 17 givenname: Ronald surname: Kaggwa fullname: Kaggwa, Ronald organization: Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK – sequence: 18 givenname: Elinor J surname: Sawyer fullname: Sawyer, Elinor J organization: Department of Research Oncology, King's College London, London, UK – sequence: 19 givenname: Isabel surname: Syndikus fullname: Syndikus, Isabel organization: Cancer Centre, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, UK – sequence: 20 givenname: Yat M surname: Tsang fullname: Tsang, Yat M organization: Department of Radiotherapy, Mount Vernon Cancer Centre Northwood, Northwood, UK – sequence: 21 givenname: Duncan A surname: Wheatley fullname: Wheatley, Duncan A organization: Department of Oncology, Royal Cornwall Hospitals NHS Trust, Truro, UK – sequence: 22 givenname: Maggie surname: Wilcox fullname: Wilcox, Maggie organization: Patient Advocate, London, UK – sequence: 23 givenname: John R surname: Yarnold fullname: Yarnold, John R organization: Department of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK – sequence: 24 givenname: Judith M surname: Bliss fullname: Bliss, Judith M organization: Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK – sequence: 25 givenname: Wail surname: Al Sarakbi fullname: Al Sarakbi, Wail – sequence: 26 givenname: Sarah surname: Barber fullname: Barber, Sarah – sequence: 27 givenname: Gillian surname: Barnett fullname: Barnett, Gillian – sequence: 28 givenname: Peter surname: Bliss fullname: Bliss, Peter – sequence: 29 givenname: John surname: Dewar fullname: Dewar, John – sequence: 30 givenname: David surname: Eaton fullname: Eaton, David – sequence: 31 givenname: Stephen surname: Ebbs fullname: Ebbs, Stephen – sequence: 32 givenname: Ian surname: Ellis fullname: Ellis, Ian – sequence: 33 givenname: Philip surname: Evans fullname: Evans, Philip – sequence: 34 givenname: Emma surname: Harris fullname: Harris, Emma – sequence: 35 givenname: Hayley surname: James fullname: James, Hayley – sequence: 36 givenname: Cliona surname: Kirwan fullname: Kirwan, Cliona – sequence: 37 givenname: Julie surname: Kirk fullname: Kirk, Julie – sequence: 38 givenname: Helen surname: Mayles fullname: Mayles, Helen – sequence: 39 givenname: Anne surname: McIntyre fullname: McIntyre, Anne – sequence: 40 givenname: Judith surname: Mills fullname: Mills, Judith – sequence: 41 givenname: Andrew surname: Poynter fullname: Poynter, Andrew – sequence: 42 givenname: Elena surname: Provenzano fullname: Provenzano, Elena – sequence: 43 givenname: Christine surname: Rawlings fullname: Rawlings, Christine – sequence: 44 givenname: Mark surname: Sculpher fullname: Sculpher, Mark – sequence: 45 givenname: Georges surname: Sumo fullname: Sumo, Georges – sequence: 46 givenname: Mark surname: Sydenham fullname: Sydenham, Mark – sequence: 47 givenname: Andrew surname: Tutt fullname: Tutt, Andrew – sequence: 48 givenname: Nicola surname: Twyman fullname: Twyman, Nicola – sequence: 49 givenname: Karen surname: Venables fullname: Venables, Karen – sequence: 50 givenname: Anna surname: Winship fullname: Winship, Anna – sequence: 51 givenname: John surname: Winstanley fullname: Winstanley, John – sequence: 52 givenname: Gordon surname: Wishart fullname: Wishart, Gordon – sequence: 53 givenname: Alastair surname: Thompson fullname: Thompson, Alastair |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/28779963$$D View this record in MEDLINE/PubMed |
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ContentType | Journal Article |
Contributor | Ebbs, Stephen Winstanley, John Barber, Sarah Sculpher, Mark Mayles, Helen Venables, Karen Rawlings, Christine Mills, Judith Barnett, Gillian Provenzano, Elena James, Hayley Kirwan, Cliona Poynter, Andrew Twyman, Nicola Dewar, John Evans, Philip Thompson, Alastair Harris, Emma Tutt, Andrew Kirk, Julie Ellis, Ian Al Sarakbi, Wail Bliss, Peter Sydenham, Mark Wishart, Gordon McIntyre, Anne Winship, Anna Sumo, Georges Eaton, David |
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Copyright | 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved. Copyright Elsevier Limited Sep 9, 2017 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license 2017 |
Copyright_xml | – notice: 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license – notice: Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved. – notice: Copyright Elsevier Limited Sep 9, 2017 – notice: 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license 2017 |
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License | This is an open access article under the CC BY license. Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). |
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Notes | Members listed in the appendix pp 90–92 Contributed equally |
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Snippet | Local cancer relapse risk after breast conservation surgery followed by radiotherapy has fallen sharply in many countries, and is influenced by patient age and... A comprehensive literature search using PubMed and MEDLINE was done before the trial opened to identify all previous pathological and clinical breast... |
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SubjectTerms | Breast - pathology Breast cancer Breast Neoplasms - pathology Breast Neoplasms - radiotherapy Breast Neoplasms - surgery Cancer Cancer therapies Carcinoma, Ductal - pathology Carcinoma, Ductal - radiotherapy Carcinoma, Ductal - surgery Clinical trials Evidence-based medicine Female Humans Mastectomy Mastectomy, Segmental - methods Metastasis Middle Aged Neoplasm Recurrence, Local - prevention & control Neoplasm Staging Patients Radiation therapy Radiotherapy Dosage Surgery Survival analysis Treatment Outcome Tumors United Kingdom |
Title | Partial-breast radiotherapy after breast conservation surgery for patients with early breast cancer (UK IMPORT LOW trial): 5-year results from a multicentre, randomised, controlled, phase 3, non-inferiority trial |
URI | https://dx.doi.org/10.1016/S0140-6736(17)31145-5 https://www.ncbi.nlm.nih.gov/pubmed/28779963 https://www.proquest.com/docview/1937767688/abstract/ https://pubmed.ncbi.nlm.nih.gov/PMC5594247 |
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