I have not read your post but there are often questions to be asked, and some do. This site is a great motivator. 10/10 for having the courage to publicly correct. Here is an example which I saved. You have to log in but do get access to some Lancet material which can be useful.
RB
http://www.thelancet.com/journals/la...3868X/fulltext
Breast cancer survival advantage with radiotherapy
Jens Overgaard a and Harry Bartelink a
Sir
Unfortunately, the analysis presented by EBCTCG1 fails to fulfil its potential to answer major questions of clinical interest and need, because the authors do not address the most pertinent issues. What are the possibilities of modern treatment techniques to avoid vascular damage? Which patient groups will benefit from radiotherapy by improving their locoregional control? Which patients will also improve their survival chances?.....
The investigators say that old-fashioned radiotherapy may cause more late morbidity. The EBCTCG accumulation of clinical trials includes trials which, by today's standards, are clearly unacceptable. The paper represents a history rather than guidance for how patients should be treated. It is also questionable if the role of radiotherapy can be described in as simple terms as in the overview, namely in the form of dose, a crude target, and then a few prognostic parameters. The issue is much more complex, especially when it comes to cardiac involvement. It is obvious from several studies2–4 that if the dose to the heart is reduced substantially, the excess non-cancer morbidity and death rate is reduced or avoided. Therefore, the radiation technique and target is of importance, but these areas were not assessed sufficiently. The investigators are not correct in their argument that the observation time is too short in the modern trials. The observation time in the Danish studies,2–4 where a modern radiotherapy technique avoiding cardiac irradiation was applied, is now 10–18 years without excess non-cancer deaths. The experience from the Stockholm trials clearly shows that the enhanced cardiac morbidity occurs within a much shorter time.
The pre-treatment assessment in the EBCTCG series is also incomplete. Some of the older trials are based on clinical assessment only in the axilla, which is no longer acceptable. The relevance of such trials in this context is therefore questionable. Information on tumour size, number of positive nodes, and nodes removed, together with menopausal and hormone receptor status, age, and the histopathology and grade of tumour are all needed to be able to describe the appropriate prognostic characteristics. Only then can clinical guidance be given for the treatment of patients today.
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