Postop Radiotherapy Not Needed in Select Breast Cancers

Roxanne Nelson

May 03, 2013

Routine postoperative radiation therapy might not be necessary in some breast cancer patients who undergo breast-conserving surgery, according to a randomized prospective study.

The risk for local recurrence and overall survival was no different between patients who had postoperative radiation and those who did not.

"Current data indicate that breast irradiation after conservative surgery might be avoided in select patients with early breast cancer without increased risk of local and distant disease recurrence," said lead author Corrado Tinterri, MD, clinical director of the Humanitas Cancer Center in Milan, Italy. But he cautioned that longer follow-up is needed to consolidate these preliminary results.

Dr. Tinterri presented highlights of the study during a press briefing at the 14th Annual Meeting of the American Society of Breast Surgeons, held in Chicago, Illinois.

For some patients, the benefits of treatment without radiation therapy are numerous. It could lead to the broader use of breast-conserving treatment, better cosmetic results, and a better quality of life; it could eliminate associated complications, risks, and direct and indirect costs; and it could allow for an easier diagnosis of local recurrence, Dr. Tinterri pointed out.

Addition to the Data

Breast-conserving surgery accompanied by postsurgical radiation is the generally accepted treatment for the majority of women with early-stage breast cancer. The elimination of follow-up radiation is a major change to current treatment protocols.

Studies have shown conflicting results when it comes to the use of radiation therapy in this setting, explained briefing moderator Deanna Attai, MD, a breast surgeon in private practice in Burbank, California.

These findings will add to the data that can be used in discussions with our patients, she said. "There will be some patients who will end up not receiving radiation."

Similar Survival and Recurrence Rates

Dr. Tinterri and colleagues wanted to investigate whether postoperative radiation is mandatory in all patients. This is "one of the most controversial issues in breast-conserving therapy," he explained.

They hoped to define a reliable risk-factor profile to identify patients who are at low risk for local recurrence who can, therefore, forgo radiation therapy.

They conducted a randomized prospective study of patients treated at 11 medical centers in Italy for a median of 9 years. All study participants had early breast cancer. They ranged in age from 55 to 75 years, had a tumor size of 2.5 cm or less, and lacked any extensive intraductal component or peritumoral vascular invasion.

The 749 patients were assigned to 1 of 2 groups: 373 underwent breast-conserving surgery and received radiation (50 Gy plus a 10 Gy boost); and 376 underwent surgery alone.

Tumor characteristics were well balanced in the 2 groups. For patients at moderate to high risk for distant recurrence, adjuvant systemic therapy was administered in accordance with the policy of the treating center.

As of December 2012 (median follow-up, 108 months), 3.4% of patients in the radiation group experienced a breast cancer recurrence, as did 4.4% in the surgery-alone group.

The risk for local recurrence and death was not significantly different in the 2 treatment groups Overall survival was similar in the radiation and surgery-alone groups (95.0% vs 96.0%), as was distant disease-free survival (96.0% and 96.5%).

Dr. Tinterri stressed that these findings are applicable to only a specific population that meets strict biologic criteria. For such women, these results are very promising.

"Whether in Italy or in the United States, we are always looking to reduce the rate of complications and for cost savings without compromising the quality of oncologic care," said Dr. Attai. "I look forward to seeing more data as they mature."

14th Annual Meeting of the American Society of Breast Surgeons. Abstract 60. Presented May 2, 2013.

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