Evidence map›Paper›PMID 30012527›Full record

Trial reportInternational journal of radiation oncology, biology, physics2018

A Randomized Comparison of Radiation Therapy Techniques in the Management of Node-Positive Breast Cancer: Primary Outcomes Analysis.

Reshma Jagsi, Kent A Griffith, Jean M Moran, Edward Ficaro, Robin Marsh, Robert T Dess, Eugene Chung, Adam L Liss, James A Hayman, Charles S Mayo and 3 more

Open access · greenAbstract readComparative StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in International journal of radiation oncology, biology, physics, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers.

0numbers the graph read from it
0cells of the map it votes in
29citing papers in PubMed
2.1field-weighted citation impact, top 13% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

29 citing papers in PubMed, 55 citations in OpenAlex.

  1. Trial
  2. Trial
  3. Phase II Study of Proton Beam Radiation Therapy for Patients With Breast Cancer Requiring Regional Nodal Irradiation.Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2019
    Trial
  4. Review
  5. Article
  6. Review
  7. Review
  8. Article
  9. Article
  10. Article
  11. Article
  12. Review
  13. Review
  14. Article
  15. Review
  16. Surface guided 3DCRT in deep-inspiration breath-hold for left sided breast cancer radiotherapy: implementation and first clinical experience in Iran.Reports of practical oncology and radiotherapy : journal of Greatpoland Cancer Center in Poznan and Polish Society of Radiation Oncology · 2022
    Article
  17. Review
  18. Article
  19. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors at 1 institution in 1 country.

Reshma JagsiDepartment of Radiation Oncology, University of Michigan, Ann Arbor, Michigan. Electronic address: rjagsi@med.umich.edu.
Kent A GriffithCenter for Cancer Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan.
Jean M MoranDepartment of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
Edward FicaroDepartment of Radiology, University of Michigan, Ann Arbor, Michigan.
Robin MarshDepartment of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
Robert T DessDepartment of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
Eugene ChungDepartment of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
Adam L LissDepartment of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
James A HaymanDepartment of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
Charles S MayoDepartment of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
Kevin FlahertyDepartment of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
James CorbettDepartment of Radiology, University of Michigan, Ann Arbor, Michigan; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
Lori PierceDepartment of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
University of Michigan–Ann Arbor · US

Funding

IMRT in the Treatment of Node-Positive Breast CancerR01CA102435 · NCI · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI PIERCE, LORI J · 2004 to 2006
$1.2M
NCI NIH HHS R01 CA102435
6 · The paper itself

Abstract

purposeAlthough inverse-planned intensity modulated radiotherapy (IMRT) and deep inspiration breath hold (DIBH) may allow for more conformal dose distributions, it is unknown whether using these technologies reduces cardiac or pulmonary toxicity of breast radiotherapy. METHODS AND MATERIALS: A randomized controlled trial compared IMRT-DIBH versus standard, free-breathing, forward-planned, three-dimensional conformal radiotherapy in patients with left-sided, node-positive breast cancer in whom the internal mammary nodal region was targeted. Endpoints included dosimetric parameters and changes in pulmonary and cardiac perfusion and function, measured by single photon emission computed tomography (SPECT) scans and pulmonary function testing performed at baseline and 1 year post treatment.

resultsOf 62 patients randomized, 54 who completed all follow-up procedures were analyzed. Mean doses to the ipsilateral lung, left ventricle, whole heart, and left anterior descending coronary artery were lower with IMRT-DIBH; the percent of left ventricle receiving ≥5 Gy averaged 15.8% with standard radiotherapy and 5.6% with IMRT-DIBH (P < .001). SPECT revealed no differences in perfusion defects in the left anterior descending coronary artery territory, the study's primary endpoint, but did reveal statistically significant differences (P = .02) in left ventricular ejection fraction (LVEF), a secondary endpoint. No differences were found for lung perfusion or function.

conclusionThe small but statistically significant benefit in preservation of cardiac LVEF observed here should motivate future studies that include LVEF as a potentially meaningful endpoint. Future studies should disaggregate the impact of IMRT from that of DIBH. Clinical practice should recognize the importance of minimizing cardiac dose, even when already low in comparison to historical levels.

Indexed as

AdultAgedAlgorithmsBreast NeoplasmsBreath HoldingFemaleHumansLungLymphatic MetastasisLymph NodesMiddle AgedPerfusionRadiation InjuriesRadiometryRadiotherapyRadiotherapy, Conformal

Identifiers

PMID30012527
PMCPMC6938718
OpenAlexW2801448601

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.