# Internal Mammary and Medial Supraclavicular Irradiation in Breast Cancer

Source: https://onco.cc/key-papers/paper-eortc-22922-n-engl-j-med-2015/  
OnCo record `paper-eortc-22922-n-engl-j-med-2015` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Published report from the EORTC 22922 trial registered as NCT00002851, in New England Journal of Medicine (2015), chosen as the most cited paper whose own text cites the registry id.

## Summary

Background: The effect of internal mammary and medial supraclavicular lymph-node irradiation (regional nodal irradiation) added to whole-breast or thoracic-wall irradiation after surgery on survival among women with early-stage breast cancer is unknown.

Methods: We randomly assigned women who had a centrally or medially located primary tumor, irrespective of axillary involvement, or an externally located tumor with axillary involvement to undergo either whole-breast or thoracic-wall irradiation in addition to regional nodal irradiation (nodal-irradiation group) or whole-breast or thoracic-wall irradiation alone (control group). The primary end point was overall survival. Secondary end points were the rates of disease-free survival, survival free from distant disease, and death from breast cancer.

Results: Between 1996 and 2004, a total of 4004 patients underwent randomization. The majority of patients (76.1%) underwent breast-conserving surgery. After mastectomy, 73.4% of the patients in both groups underwent chest-wall irradiation. Nearly all patients with node-positive disease (99.0%) and 66.3% of patients with node-negative disease received adjuvant systemic treatment. At a median follow-up of 10.9 years, 811 patients had died. At 10 years, overall survival was 82.3% in the nodal-irradiation group and 80.7% in the control group (hazard ratio for death with nodal irradiation, 0.87; 95% confidence interval [CI], 0.76 to 1.00; P=0.06). The rate of disease-free survival was 72.1% in the nodal-irradiation group and 69.1% in the control group (hazard ratio for disease progression or death, 0.89; 95% CI, 0.80 to 1.00; P=0.04), the rate of distant disease-free survival was 78.0% versus 75.0% (hazard ratio, 0.86; 95% CI, 0.76 to 0.98; P=0.02), and breast-cancer mortality was 12.5% versus 14.4% (hazard ratio, 0.82; 95% CI, 0.70 to 0.97; P=0.02). Acute side effects of regional nodal irradiation were modest.

Conclusions: In patients with early-stage breast cancer, irradiation of the regional nodes had a marginal effect on overall survival. Disease-free survival and distant disease-free survival were improved, and breast-cancer mortality was reduced. (Funded by Fonds Cancer; ClinicalTrials.gov number, NCT00002851.).

Indexed on Europe PMC as PubMed record 26200978 (DOI 10.1056/nejmoa1415369). Its abstract cites the registry id NCT00002851, which is how it was matched to this trial; no figure has been checked by an editor.

## Fields

- Kind: Key paper
- Last checked: 2026-09-22
- Tags: europepmc-ingest
- Journal: New England Journal of Medicine
- Year: 2015
- DOI: 10.1056/nejmoa1415369
- Authors: Poortmans PM, Collette S, Kirkove C, et al.
- What it means: This is the paper Europe PMC returns for registry id NCT00002851 with the most citations, so it is the natural first reading for anyone following the EORTC 22922 trial. Read the abstract above alongside the trial page and the registry entry; the record was linked automatically and its figures have not been checked by hand.
- Caveats: Matched to the trial by the registry id cited in the Europe PMC record; the summary reproduces the record's abstract and no figure has been verified against the full paper.

## Sources

- N Engl J Med 2015: https://doi.org/10.1056/nejmoa1415369
- PubMed: https://pubmed.ncbi.nlm.nih.gov/26200978/
- Europe PMC: https://europepmc.org/article/MED/26200978
- ClinicalTrials.gov NCT00002851: https://clinicaltrials.gov/study/NCT00002851

## Connected records

- trials: [EORTC 22922/10925](https://onco.cc/trials/eortc-22922/)
- journals: [New England Journal of Medicine](https://onco.cc/journals/nejm/)

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