Armando Orlandi, Medical Director at the Agostino Gemelli University Hospital Foundation IRCCS, shared a post on LinkedIn about a recent article by I.H. Kunkler et al., adding:
“SUPREMO Trial: PMRT Does NOT Improve Survival in Intermediate-Risk Breast Cancer
NEJM publishes 10-year results that will change post-mastectomy practice.
Who Are Intermediate-Risk Patients?
- pT1-2N1: Tumor ≤5cm with 1-3 positive axillary nodes
- pT2-3N0: Tumor >2cm, node-negative BUT with: • Histologic grade 3 and/or • Lymphovascular invasion (LVI)
- Patients who until now routinely received chest-wall RT post-mastectomy
Results (n=1,607, median 9.6-year follow-up):
- 10-year OS: 81.4% (RT) vs 81.9% (no RT) – P=0.80
- Chest-wall recurrence: 1.1% vs 2.5% (<2% difference)
- DFS and DMFS: no difference
What Changes In Clinical Practice:
Before (EBCTCG pre-2000 data):
- Routine post-mastectomy RT, Based on 15-20% local recurrence rates
Now (modern systemic therapy era):
- Chest-wall RT can be safely OMITTED
- Local recurrence <3% without RT
- No survival impact
Immediate Clinical Impact:
- Medical Oncologists: Modern systemic therapy (anthracyclines, taxanes, anti-HER2, endocrine) effectively controls disease
- Radiation Oncologists: Safe chest-wall RT de-escalation; consider regional nodal RT on case-by-case basis
- Breast Surgeons: Greater freedom for immediate reconstruction, reduced RT-related complications
- Patients: Avoid late cardiopulmonary toxicity, improved QoL
- EXCEPTION: Triple-negative: concerning signal (HR 1.91) – requires caution and further study
Take-Home Message:
Modern systemic therapies have raised the threshold beyond which local RT adds survival benefit.
In intermediate-risk with contemporary systemic therapy:
- Chest-wall RT does NOT improve OS
- De-escalation is safe and recommended.”
Title: Ten-Year Survival after Postmastectomy Chest-Wall Irradiation in Breast Cancer
Authors: I.H. Kunkler, N.S. Russell, N. Anderson, R. Sainsbury, J.M. Dixon, D. Cameron, J. Loncaster, M. Hatton, H. Westenberg, J. Clarke, H. McCarty, R. Evans, K. Geropantas, V. Wolstenholme, A. Alhasso, P. Woodings, L. Barraclough, N. Bayman, R. Welch, F. Muturi, T. McEleney, J. Burns, K. Riddle, E. Macdonald, J. Dunlop, N. Sergenson, G. van Tienhoven, K.J. Taylor, J.M.S. Bartlett, T. Piper, G. Velikova, E. Aird, B. Chua, C. Hurkmans, K. Venables, L.J. Williams, J.S. Thomas, A.M. Hanby, M. Maclennan, S. Cleator, E.T. Verghese, Y. Li, S. Wang, P. Canney
Read the Full Article on The New England journal of Medicine
More posts featuring Armando Orlandi.