ADJUVANT RADIOTHERAPY AND CHEMOTHERAPY IN NODE-POSITIVE PREMENOPAUSALWOMEN WITH BREAST-CANCER

Background Radiotherapy after mastectomy to treat early breast cancer has been known since the 1940s to reduce rates of local relapse. Howev er, the routine use of postoperative radiotherapy began to decline in the 1980s because it failed to improve overall survival. We prospectiv ely tested the efficacy of combining radiotherapy with chemotherapy, M ethods From 1978 through 1986, 318 premenopausal women with node-posit ive breast cancer were randomly assigned, after modified radical maste ctomy, to receive chemotherapy plus radiotherapy or chemotherapy alone . Radiotherapy was given to the chest wall and locoregional lymph node s between the fourth and fifth cycles of cyclophosphamide, methotrexat e, and fluorouracil. Results After 15 years of follow-up, the women as signed to chemotherapy plus radiotherapy had a 33 percent reduction in the rate of recurrence (relative risk, 0.67; 95 percent confidence in terval, 0.50 to 0.90) and a 29 percent reduction in mortality from bre ast cancer (relative risk, 0.71; 95 percent confidence interval, 0.51 to 0.99), as compared with the women treated with chemotherapy alone. Conclusions Radiotherapy combined with chemotherapy after modified rad ical mastectomy decreases rates of locoregional and systemic relapse a nd reduces mortality from breast cancer. (C) 1997, Massachusetts Medic al Society.