1. SUPREMO S elective U se of P ostoperative R adiotherapy aft E r M astect O my MRC SUPREMO (BIG 2-04) S elective U se of P ostoperative R adiotherapy aft E r M astect O my Phase III randomised trial of chest wall RT in intermediate- risk breast cancer Kunkler I, Canney P, Price A,Prescott R, Hophood P,Dixon J, Sainsbury R,Aird E, Thomas G,Bowman A,Thomas J, Bartlett J,Dunlop J, Denvir M,McDonagh T,Russell N

4. Trials of PMRT in premen1-3 N+ + adjuvant CMFchemo (Fowble,1999) Trial No Redn LRR OS % C OS% C+RT P value Int (yr) B.C 183 23% 48 64 0.06 15act Den’k pre 1061 23% 54 62 - 10act Glas pre 141 NS 84 78 .40 5act Dana 83 3% 85 77 >.05 4.4me

6. Effects of RT on breast cancer mortality and all cause mortality after breast conserving / mastectomy and axillary clearance (EBCTCG; Lancet 2005;366:2087-2106

7. Oxford overview 2006; RT trials and breast cancer mortality at 20 yr, mastectomy & axillary clearance by nodal status Breast ca mortality (%) Breast ca mortality(%) 20 yr gain/loss(%) Path nodal status No RT RT pNO 28.7 30.2 -1.6 NS pN1-3 54.2 47.7 +6.4 2p=0.002 pN =/>4N+ 81.5 70.8 +10.7 2p=0.0008

9. PMRT 1-3 N+ with 8 or more nodes DBCG 82b,c trial Overgaard et al,Radiother Oncol,2007 RT No RT p value LRR 4% 27% <0.001 Overall survival 57% 48% 0.03

10. Whelan et al JCO 2000 2000;18:1220-29 0.73 - 1.38 1.00 5 YES 0.25 0.70 - 0.89 0.79 13 NO p 95% CI Odds ratio No of studies Anthracycline use

11. Overall and relapse free survival NEAT trial (Poole et al,NEJM,2006

14. Randomisation in SUPREMO Chest wall irradiation Vs No chest wall irradiation

17. Biological,cardiac, QL and health economic substudies

21. SUPREMO collaboration 136 centres in 24 countries