The edition · Oncology
Three weeks of post-mastectomy radiotherapy held up at ten years
Ten-year results from a Chinese phase 3 trial show 15-fraction chest wall and nodal radiotherapy after mastectomy gave locoregional control and late toxicity similar to 25 fractions. Plus the infections behind one in eight cancers, anaesthetic choice and survival after gastrectomy, and three Hodgkin biomarkers that failed validation.
The edition in brief
Hypofractionated post-mastectomy radiotherapy: the CHN HYPOPMRT trial randomised 820 women with high-risk, mostly stage III breast cancer after modified radical mastectomy to 43.5 Gy in 15 fractions or 50 Gy in 25 fractions to the chest wall and supraclavicular region. At a median follow-up of 11.5 years, locoregional recurrence at 10 years was 12.0% against 10.3% (HR 1.19, 0.79–1.82), and grade 3 late effects were rare and similar, with no brachial plexopathy. Infection-attributable cancer: 2.3 million new cancers in 2024, 12% of the global total, were attributable to 12 infectious agents, led by H pylori (760,000) and HPV (750,000), then hepatitis B, Epstein-Barr virus and hepatitis C. Anaesthesia: a meta-analysis of 13 mainly retrospective studies found total intravenous anaesthesia associated with better overall survival than volatile anaesthesia after oesophagogastric cancer surgery (HR 0.80), driven by gastrectomy, with no clear effect after oesophagectomy. Hodgkin lymphoma: in 257 patients from the EORTC-GELA H9 trial, c-MET, HLA class II and CD68 immunohistochemistry did not predict progression-free survival.
One in eight new cancers worldwide was attributable to infection in 2024
Treat infection control — HPV and hepatitis B vaccination, hepatitis and H pylori treatment, cervical screening — as cancer prevention in your own practice.
Intravenous anaesthesia was associated with better survival after gastrectomy for cancer
Treat the link between intravenous anaesthesia and survival after gastrectomy as a hypothesis for trials, not a reason to change practice.
c-MET, HLA class II and CD68 did not predict outcome in early Hodgkin lymphoma
Keep treatment decisions in early Hodgkin lymphoma on clinical risk factors and PET response, not these tissue biomarkers.
Screen for hepatitis B before anti-CD20 therapy and chemotherapy
Check hepatitis B serology before chemotherapy and give prophylaxis to those at risk of reactivation.
Fifteen-fraction post-mastectomy radiotherapy matched 25 fractions at ten years
Fifteen-fraction post-mastectomy radiotherapy is a well-supported option for high-risk breast cancer, including with supraclavicular nodal treatment.
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