Many women with breast cancer who undergo a lumpectomy follow that up with endocrine therapy, such as chemotherapy, and radiation treatments. But a new study suggests one of those might not be needed to ensure a low risk of recurrence.
Reshma Jagsi, MD, of Emory University and Winship Cancer Institute in Atlanta, and colleagues recruited postmenopausal women 50-69 years old with low-risk early HR-positive breast cancer who had undergone breast-conserving surgery, such as a lumpectomy.
Although earlier studies have shown women 65-70 were successfully treated without radiation, Jagsi and her team wanted to see if younger women could achieve the same results.
The researchers enrolled 200 women from June 2015 through October 2018. “Among the 186 patients with clinical follow-up of at least 56 months, overall and breast cancer–specific survival rates at 5 years were both 100%,” the study authors wrote. The results were published in the Journal of Clinical Oncology.
“These findings shouldn’t be generalized to patients who have less extensive surgery (than required in the clinical trial) or who are expected not to be compliant with endocrine therapy,” Jagsi said during a presentation at the San Antonio Breast Cancer Symposium, as reported by MedPage Today. “The other cautionary note is perhaps even more important to reflect on. Advances in radiation therapy have substantially reduced the toxicity and short-term burden of treatment, even since the initiation of this trial in 2015. The patients eligible for [this trial] can also receive radiation treatment in five fractions or less.”
“The worst thing we can do for our patients is make them think radiation is the ‘Danger. Radiation’ sign because it is harsh and toxic and brutal and awful,” she continued. “There are many patients who benefit meaningfully from radiation treatment. We don’t want to go too far in overstating the interest in omitting radiation therapy. Of course, we know that some women do wish to avoid the burden and potential toxicity of radiation therapy altogether, even though it is lower than it once was.”
According to MedPage, there are four ongoing trials that could provide more answers about omitting radiation treatment.
“Long-term follow-up of this trial and others are essential to help determine whether the option of avoiding initial radiotherapy can be offered to a broader group of women than current guidelines recommend,” Jagsi told the symposium audience. “These efforts strive to empower patients with choices and return to them a sense of agency that can be deeply meaningful in the context of a recent cancer diagnosis, which every single person in this room knows takes away a sense of control.”
