Radiation After Surgery Does Not Improve Survival in Older Breast Cancer Patients, Study Finds
Michelle Milliken
Early stage, hormone-receptor positive breast cancer is generally treated with a lumpectomy followed by radiation and hormone therapy. However, radiation can have side effects, including fatigue, skin issues, lymphedema, and low blood counts, which may be harder for older patients to manage. In light of this, a new study aimed to see if older women with this form of cancer could safely forgo radiation post-lumpectomy.
The research, published in the New England Journal of Medicine, looked at the rates of survival, recurrence, and metastasis in women aged 65 and older who did not get radiation therapy for their early stage breast cancer, compared with those who did. This was among patients deemed low risk, who had tumors three centimeters or smaller, no lymph node involvement underneath the armpit, and a likelihood of responding to hormone treatment.
The researchers - which included team members from the University of Edinburgh and the Western General Hospital in Edinburgh - enrolled more than 1,300 patients in a clinical trial to test this. All of the women underwent lumpectomies followed by at least five years of hormone therapy. Half of them also had radiation therapy for three to five weeks after their surgeries. Their subsequent health was tracked through annual clinic visits and breast scans.
The team found that, after 10 years, the risk of recurrence was 9.5% in those who had forgone radiation, compared to 0.9% in the radiation group. While that is a notable difference, the team says both fall into the accepted range of recurrence according to current guidelines.
However, despite the differences in the cancer returning, there was not a higher rate of metastasis in the group without radiation, and survival rates were the same in both groups. Most of the deaths in the study period were due to other reasons.
The researchers say their findings suggest that radiation may be safely avoided in women 65 and older with early stage, hormone-receptor positive breast cancers.
Ian Kunkler, the study's first author and professor of clinical oncology at the University of Edinburgh, says, "Radiotherapy can place a heavy burden on patients, particularly older ones. Our findings will help clinicians guide older patients on whether this particular aspect of early breast cancer treatment can be omitted in a shared decision-making process, which weighs up all the risks and benefits."
Another study on this topic found something similar: That women over 70 with early stage ER-positive, HER2-negative breast cancer had the same survival and recurrence rates regardless of whether they'd had sentinel lymph node biopsies or radiation.
