title: Adjuvant radiotherapy and chemotherapy in breast cancer: 30 year follow-up of survival.
abstract: BACKGROUND
  The long term outcome (more than 15 years) of adjuvant treatment in patients with primary operable breast cancer has rarely been examined.
  
  
  METHODS
  A randomised clinical trial of radiotherapy, chemotherapy (28 day cycles of cyclophosphamide, methotrexate and 5-fluorouracil) or both on women with primary operable breast cancer (n = 322) was followed-up for a median of 27 years.
  
  
  RESULTS
  260 (81%) patients died, 204 (78%) from breast cancer. Cancer specific survival (SE) at 10 years, 20 years and 30 years was 41 (3)%, 34 (3)% and 33 (3)% respectively. Presence of more than 3 involved lymph nodes increased cancer-specific mortality (HR 1.88, 95% CI 1.34-2.63) after adjustment for age, socio-economic deprivation and adjuvant treatment. Both age (HR 1.63, 95% CI 1.19-2.22) and involved lymph nodes (HR 1.59, 95% CI 1.17-2.14) were significant predictors of all-cause mortality after adjustment for other factors. There was no significant difference in all-cause or cancer-specific survival between patients in each of the 3 treatment arms.
  
  
  CONCLUSIONS
  The present study highlights the long term impact of node positive disease but does not indicate that any regimen was associated with significantly better long-term survival.
authors.affiliation: University Department of Surgery, Faculty of Medicine, University of Glasgow, Glasgow, UK, G12 8RZ.
authors.forename: Colin S
authors.initials: CS
authors.lastname: McArdle
authors.forename: Donald C
authors.initials: DC
authors.lastname: McMillan
authors.forename: Nicola
authors.initials: N
authors.lastname: Greenlaw
authors.forename: David S
authors.initials: DS
authors.lastname: Morrison
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D017024:Chemotherapy, Adjuvant; D003520:Cyclophosphamide / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D018714:Radiotherapy, Adjuvant; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D003520:Cyclophosphamide; D005472:Fluorouracil; D008727:Methotrexate