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document
Long-term follow-up of the Stockholm randomized trials of postoperative radiation therapy versus adjuvant chemotherapy among 'high risk ' pre- and postmenopausal breast cancer patients . For many years , loco-regional radiotherapy was the standard postoperative treatment for node positive breast cancer patients in Sweden . Because of encouraging results from trials of adjuvant chemotherapy in the mid 1970s , the Stockholm Breast Cancer Study Group decided to directly compare postoperative radiation ( RT ) with adjuvant CMF-type chemotherapy ( CT ) . Long-term results are presented from two randomized trials of RT versus CT in pre- ( n = 547 ) and postmenopausal ( n = 679 ) patients , respectively , with node positive disease or a tumour diameter > 30 mm . RT substantially reduced loco-regional recurrences among both pre- and postmenopausal patients ( relative hazard RT versus CT : 0.67 and 0.43 , respectively ) . Among premenopausal patients distant metastases occurred less frequently in the CT group ( relative hazard : 1.68 , p > 0.001 ) resulting in an improved recurrence-free survival ( p = 0.04 ) . Overall survival was also better with CT ( cumulative survival at 15 years : 50 % and 44 % in the CT and RT groups , respectively ) but the difference was not statistically significant . Among the postmenopausal patients there were no substantial differences in terms of recurrence-free or overall survival between the treatment groups . The risk of a second primary malignancy , however , was doubled in the RT group ( p > 0.01 ) . The most pronounced excess concerned second lung cancers occurring after 10 years . The cumulative incidence at 20 years was estimated at 0.3 % and 3.7 % in the CT and RT groups , respectively . The trials illustrate the role of radiotherapy in preventing loco-regional recurrences among high-risk patients , as well as the need for systemic treatment to control the disease systemically .
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Intervention_Physical
postoperative radiation therapy
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Intervention_Physical
adjuvant chemotherapy
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Intervention_Physical
adjuvant chemotherapy
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Intervention_Physical
postoperative radiation
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Intervention_Physical
adjuvant CMF-type chemotherapy
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Intervention_Pharmacological
RT
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Intervention_Pharmacological
CT
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Outcome_Physical
loco-regional recurrences
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Outcome_Physical
distant metastases
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Outcome_Mortality
recurrence-free survival
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Outcome_Mortality
Overall survival
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Outcome_Mortality
recurrence-free or overall survival
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Outcome_Physical
risk of a second primary malignancy
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Outcome_Physical
second lung cancers
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Outcome_Physical
cumulative incidence at 20 years
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Outcome_Physical
loco-regional recurrences
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Participant_Condition
node positive breast cancer patients in Sweden .