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Breast-Conserving Surgery with or without Irradiation in Early Breast Cancer
Ian H Kunkler1, Linda J Williams1, Wilma J L Jack1
1From the University of Edinburgh (I.H.K., L.J.W., D.A.C., J.M.D.) and Western General Hospital (W.J.L.J.) - both in Edinburgh.
The New England Journal of Medicine
|February 15, 2023
Summary
Omitting radiotherapy after breast-conserving surgery for older women with early-stage, hormone receptor-positive breast cancer is associated with higher local recurrence rates. However, it does not negatively impact distant recurrence or overall survival, offering a potential treatment option.
Area of Science:
- Oncology
- Radiotherapy
- Breast Cancer Treatment
Background:
- Limited level 1 evidence exists for omitting radiotherapy post-breast-conserving surgery in older women with hormone receptor-positive early breast cancer on adjuvant endocrine therapy.
- This study addresses the evidence gap regarding radiotherapy omission in a specific, low-risk patient population.
Purpose of the Study:
- To evaluate the efficacy and safety of omitting whole-breast irradiation after breast-conserving surgery in older women with hormone receptor-positive early breast cancer.
- To compare local recurrence rates, regional recurrence, breast cancer-specific survival, distant recurrence, and overall survival between patients receiving radiotherapy and those not receiving it.
Main Methods:
- A phase 3 randomized trial involving 1326 women aged 65 or older with hormone receptor-positive, node-negative, T1 or T2 primary breast cancer.
- Patients underwent breast-conserving surgery with clear margins and adjuvant endocrine therapy, then were randomized to receive whole-breast irradiation or no irradiation.
- The primary endpoint was local breast cancer recurrence, with secondary endpoints including regional recurrence, distant recurrence, and survival outcomes, assessed over a median follow-up of 9.1 years.
Main Results:
- The 10-year cumulative incidence of local breast cancer recurrence was significantly higher in the no-radiotherapy group (9.5%) compared to the radiotherapy group (0.9%).
- Despite increased local recurrence, the 10-year incidence of distant recurrence as the first event was similar between groups (1.6% vs. 3.0%).
- Overall survival at 10 years was nearly identical in both groups (80.8% vs. 80.7%), with no substantial differences in regional recurrence or breast cancer-specific survival.
Conclusions:
- Omission of radiotherapy in older women (≥65 years) with low-risk, hormone receptor-positive early breast cancer after breast-conserving surgery and endocrine therapy increases local recurrence.
- Radiotherapy omission did not adversely affect distant recurrence as the first event or overall survival in this patient cohort.
- The findings suggest that omitting radiotherapy may be a viable option for select older women with early breast cancer, balancing local control with treatment burden.
