Regional Nodal Irradiation in Early-Stage Breast Cancer MA-20 Trial

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Most women with breast cancer who undergo breast-conserving surgery receive whole-breast irradiation
  • The MA20 trial examined whether the addition of regional nodal irradiation to whole-breast irradiation improved outcomes
  • The MA-20 trial:
    • Was a randomized trial that included women with:
      • Node-positive or high-risk node-negative breast cancers
    • Randomizing patients to radiation therapy with or without comprehensive regional nodal irradiation:
      • Which includes internal mammary nodes, supraclavicular nodes, axillary nodes
    • High-risk node negative patients:
      • Were those with a tumor > 5 cm, or > 2 cm and < 10 lymph nodes dissected with at least one of the following:
        • Grade 3, ER negative, or lymphovascular space invasion
      • A total of 1,832 women were included and with 10-year follow-up
    • Results:
      • The median follow-up was 9.5 years
      • At the 10-year follow-up, there was no significant between-group difference in survival:
        • With a rate of 82.8% in the nodal-irradiation group and 81.8% in the control group (hazard ratio, 0.91; 95% confidence interval [CI], 0.72 to 1.13; P=0.38)
      • The rates of disease-free survival:
        • Were 82.0% in the nodal-irradiation group and 77.0% in the control group (hazard ratio, 0.76; 95% CI, 0.61 to 0.94; P=0.01)
      • Patients in the nodal-irradiation group had higher rates of grade 2 or greater acute pneumonitis (1.2% vs. 0.2%, P=0.01) and lymphedema (8.4% vs. 4.5%, P=0.001)
      • Conclusion of the trial:
        • Among women with node-positive or high-risk node-negative breast cancer, the addition of regional nodal irradiation to whole-breast irradiation did not improve overall survival but reduced the rate of breast-cancer recurrence
  • References
    • Whelan TJ, Olivotto IA, Pareulekar WR, et al. Regional nodal irradiation in early-stage breast cancer. N Engl J Med. 2015;373(4):307-316.
    • Poortmans PM, Collette S, Kirkove C, et al. Internal mammary and medial supraclavicular irradiation in breast cancer. N Engl J Med. 2015;373(4):317-327.
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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