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Voluntary Breath-hold Technique for Reducing Heart Dose in Left Breast Radiotherapy

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Omitting Radiotherapy after Breast-Conserving Surgery in Luminal A Breast Cancer.

Timothy J Whelan¹, Sally Smith¹, Sameer Parpia¹

¹From the Department of Oncology, McMaster University and the Division of Radiation Oncology, Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (T.J.W., I.S.D., J.R.W.), the Division of Radiation Oncology, Department of Surgery, University of British Columbia and Radiation Therapy Program, BC Cancer Agency, Victoria (S.S.), the Department of Oncology, McMaster University, Hamilton, ON (S. Parpia, G.P., M.N.L.), the Department of Radiation Oncology, University of Toronto, and the Radiation Medicine Program, Princess Margaret Cancer Centre (A.W.F., F.-F.L.), the Department of Pathology, University of Toronto (A.B.), and the Department of Radiation Oncology, University of Toronto and Sunnybrook Odette Cancer Centre (E.R.), Toronto, the Department of Radiation Oncology, University of Ottawa and Ottawa Regional Cancer Centre, Ottawa (L.C.), the Department of Radiation Oncology, University of Toronto and Royal Victoria Regional Health Centre, Barrie, ON (C.S.), the Department of Radiation Oncology, Laurentian University and Radiation Treatment Program, Northeast Cancer Centre, Health Sciences North, Sudbury, ON (J.B.), the Department of Radiation Oncology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC (S. Provencher), the Department of Radiation Oncology, Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC (V.T.), the Department of Laboratory Medicine and Pathobiology, and the Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto (A.M.M.), the Department of Pathology and Laboratory Medicine, University of British Columbia, and the BC Cancer Agency, Vancouver (Z.K.), the Department of Radiation Oncology, University of Manitoba and Cancer Care Manitoba, Winnipeg (M.A.A.), the Department of Radiation Oncology, University of British Columbia and Radiation Therapy Program, BC Cancer Agency, Vancouver (K.D.V.), the Department of Radiation Oncology, McGill University, Montreal (T.H.), and the Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver (T.O.N.) - all in Canada.

The New England Journal of Medicine

|August 16, 2023

Summary

This summary is machine-generated.

For post-surgery early-stage luminal A breast cancer patients over 55, omitting radiotherapy is safe. Local recurrence rates remained low at 5 years without radiation, indicating a viable treatment option.

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Area of Science:

Oncology
Radiotherapy
Breast Cancer Research

Background:

Adjuvant radiotherapy is standard after breast-conserving surgery to lower local recurrence risk.
Radiotherapy presents inconvenience, cost, and potential side effects.
Clinicopathologic factors alone are insufficient for identifying low-risk patients who could avoid radiotherapy.

Purpose of the Study:

To evaluate the safety and efficacy of omitting adjuvant radiotherapy in select early-stage, luminal A breast cancer patients.
To determine if a low 5-year local recurrence rate (<5%) could be achieved without radiotherapy in this patient group.

Main Methods:

A prospective cohort study enrolled 500 women (≥55 years) with T1N0, grade 1-2, luminal A breast cancer post-breast-conserving surgery and endocrine therapy.
Patients with a low Ki67 index (≤13.25%) were enrolled and did not receive radiotherapy.
The primary endpoint was local recurrence in the ipsilateral breast, with a predefined acceptable 5-year cumulative incidence upper boundary.

Main Results:

At 5 years, the local recurrence rate was 2.3% (90% CI, 1.3-3.8%), meeting the prespecified acceptable risk threshold.
Contralateral breast cancer occurred in 1.9% of patients.
Overall recurrence of any type was observed in 2.7% of patients.

Conclusions:

Omitting radiotherapy in women ≥55 with T1N0, grade 1-2, luminal A breast cancer treated with breast-conserving surgery and endocrine therapy results in a low 5-year local recurrence incidence.
This approach demonstrates the potential to safely avoid radiotherapy for select early-stage breast cancer patients.