Omission of Radiotherapy After Breast-Conserving Surgery Explored

Feb 16, 2023

THURSDAY, Feb. 16, 2023 (HealthDay News) — For women with hormone receptor-positive, node-negative, T1 or T2 primary breast cancer undergoing breast-conserving surgery, omission of radiotherapy is associated with an increased incidence of local recurrence but has no effect on distant recurrence or overall survival, according to a study published in the Feb. 16 issue of the New England Journal of Medicine.

Ian H. Kunkler, M.B., B.Chir., from the University of Edinburgh in the United Kingdom, and colleagues conducted a phase 3 randomized trial of the omission of irradiation among women aged 65 years or older with hormone receptor-positive, node-negative, T1 or T2 primary breast cancer treated with breast-conserving surgery with clear excision margins and adjuvant endocrine therapy. Participants were randomly assigned to whole-breast irradiation (658 women) or no irradiation (668 women).

Patients were followed for a median of 9.1 years. The researchers found that the cumulative incidence of local breast cancer recurrence within 10 years was 9.5 and 0.9 percent in the no-radiotherapy and radiotherapy groups, respectively (hazard ratio, 10.4). The 10-year incidence of distant recurrence as the first event was not higher in the no-radiotherapy group (1.6 versus 3.0 percent). The two groups had almost identical overall survival at 10 years (80.8 and 80.7 percent with no radiotherapy and radiotherapy, respectively). No substantial difference was seen between the groups in the incidence of regional recurrence or breast cancer-specific survival.

“Taken together, these data will help patients navigate these complex choices so that they can make well-informed and prudent decisions for the management of their breast cancer,” write the authors of an accompanying editorial.

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