ArticlesFavourable and unfavourable effects on long-term survival of radiotherapy for early breast cancer: an overview of the randomised trials
Introduction
In women with “early” breast cancer, all detectable cancer is, by definition, restricted to the breast (and, in women with node-positive disease, the local lymph nodes), and can be removed surgically. However, clinically undetected deposits of neoplastic disease may remain, either locally or at distant sites, that eventually develop into clinically detectable recurrence. Local deposits can be treated with radiotherapy, and there have been many randomised trials of the effects of particular types of radiotherapy on local recurrence, distant recurrence, death from breast cancer, and long-term overall survival. Previous systematic overviews (meta-analyses) of their results1, 2, 3 indicated that, although the main types of radiotherapy in those trials greatly reduced the incidence of local recurrence, they made little difference to overall survival during the first decade or so. However, uncertainty remained about the longer-term effects of radiotherapy on breast cancer mortality and on other mortality, and how the balance between these depends on the type of patient and type of radiotherapy.
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Trials
Every 5 years since 1984–85, the EBCTCG has undertaken systematic overviews of the randomised trials in early breast cancer,3, 4, 5, 6, 7, 8, 9 using standard procedures for trial identification and data checking.4, 5 This report is of the randomised trials begun before 1990 that were unconfounded—ie, compared radiotherapy plus other treatments (including breast surgery) versus the same other treatments without radiotherapy.
Of 45 trials identified, 40 were available, involving 19 582 women with
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1Information about collaborators is given at the end of the paper