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An extra dose of radiotherapy aimed at the small area the lump came from, given after the whole breast has been treated. It cuts the chance of the cancer coming back in that breast by about a third, does not help anyone live longer, and triples the chance of the breast becoming hard and scarred.
EORTC 22881-10882 randomised 5,318 patients after complete excision and 50 Gy of whole-breast irradiation to a further 16 Gy to the tumour bed or to nothing more, and followed them for a median 17.2 years. Twenty-year overall survival was 59.7 percent with the boost and 61.1 percent without (hazard ratio 1.05, 99 percent confidence interval 0.92 to 1.19, p=0.323). The twenty-year cumulative incidence of recurrence in the treated breast was 12.0 percent with the boost against 16.4 percent without (hazard ratio 0.65, 0.52 to 0.81, p<0.0001). Severe fibrosis at twenty years was 5.2 percent with the boost against 1.8 percent without (p<0.0001).
The trial's own reading of its data is that the absolute benefit is largest in young patients and that the extra dose can be avoided in most patients over 60, because the recurrence risk they start from is low enough that a one-third reduction saves few events while the fibrosis is the same for everyone.
NICE NG101 recommendation 1.13.17 offers an external beam boost to women with invasive breast cancer and a high risk of local recurrence following whole-breast radiotherapy, and 1.13.18 requires that the risk of side effects be explained. Neither recommendation defines high risk numerically, so the judgement is local and usually rests on age, grade, margin width and lymphovascular invasion.
Showing the technology this term belongs to: IMRT / IGRT (modern external beam).
Shares Leaving radiotherapy out, EORTC 10801, Lumpectomy (breast-conserving surgery), Resection margins (R0 / R1 / R2).
Shares IMPORT LOW, Partial-breast irradiation, Hypofractionation (fewer, larger radiotherapy doses), HER2-positive breast cancer.
Shares IMPORT LOW, Partial-breast irradiation, Lumpectomy (breast-conserving surgery), HER2-positive breast cancer.
Shares EORTC 10801, Lumpectomy (breast-conserving surgery), Resection margins (R0 / R1 / R2), HER2-positive breast cancer.
Shares Partial-breast irradiation, Hypofractionation (fewer, larger radiotherapy doses), HER2-positive breast cancer, Breast cancer (all types).
Shares EORTC 10801, Lumpectomy (breast-conserving surgery), HER2-positive breast cancer, Breast cancer (all types).
Shares Partial-breast irradiation, Hypofractionation (fewer, larger radiotherapy doses), HER2-positive breast cancer, Breast cancer (all types).
Shares Leaving radiotherapy out, Hypofractionation (fewer, larger radiotherapy doses), HER2-positive breast cancer, Breast cancer (all types).