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Adjuvant irradiation for breast cancer

BMJ 2000; 320 doi: (Published 03 June 2000) Cite this as: BMJ 2000;320:1485

Modern radiotherapy techniques should reduce cardiovascular mortality

  1. Ian Kunkler, senior lecturer in clinical oncology (
  1. University Department of Clinical Oncology, Western General Hospital, Edinburgh EH4 2XU

    The use of postoperative adjuvant irradiation in breast conservation and after mastectomy is increasing. However, concerns exist about the risks of cardiac morbidity and mortality induced by radiation. These risks are worrying because three randomised trials have suggested that locoregional irradiation after mastectomy, when combined with appropriate systemic therapy, improves local control and survival compared with systemic therapy alone in both premenopausal and postmenopausal women at high risk of local relapse.13 In 1995 the Early Breast Cancer Trialists' Collaborative Group contributed a valuable overview of 36 randomised trials of surgery and radiotherapy (including 28 405 women for whom data on mortality were available).4 There was no difference in overall survival between the irradiated and non-irradiated groups after mastectomy or breast conserving surgery. Although radiotherapy did reduce deaths from breast cancer, it was associated with an increased risk of death from other causes.

    These other deaths were mainly cardiovascular. Patients aged 60 or older at the time of randomisation were particularly at risk of death from causes other than breast cancer. Data were not included on the laterality of the primary …

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