Elderly breast cancer patients may choose not to be irradiated: study

February 16, 2023 – Elderly breast cancer patients may consider skipping weeks of grueling radiation therapy after lumpectomy surgery, a new study finds.

THE studypublished today in The New England Journal of Medicine, showed that women aged 65 and older who were randomly selected not to have radiation therapy had the same 10-year survival rate as women who received the additional treatment. But those who did not receive radiation therapy were much more likely to have their cancer come back and need more treatment.

“Radiation therapy can place a heavy burden on patients, especially older ones. Our results will help clinicians advise older patients whether this particular aspect of early breast cancer treatment can be omitted in a shared decision-making process, which weighs all the risks and benefits,” said the lead author of the report. study, Ian Kunkler, professor of clinical oncology. at the University of Edinburgh, said in a statement.

Side effects of radiation have been linked to heart problems and secondary cancers, and there have been few studies of this in older patients with breast cancer.

The phase III trial enrolled 1,326 patients aged 65 and over with hormone-responsive breast cancer that had not spread to other parts of the body, such as the lymph nodes, and whose the tumors measured 3 centimeters or less. They all had a lumpectomy and took medications that have been shown to reduce the risk of recurrence of hormone-sensitive cancers.

Patients were to receive either radiation therapy to the entire breast or no radiation therapy at all.

There is a trade off of skipping radiation, the results showed. Local recurrence (i.e. the breast cancer was found in the same breast) within 10 years was significantly lower in the group that received the additional treatment – 0.9% of women who received radiation therapy had a recurrence, compared with 9.5% of women who did not receive radiation therapy.

“Avoiding a local recurrence is valuable to many women,” said Naamit Kurshan Gerber, MD, radiation oncologist at NYU Langone’s Perlmutter Cancer Center. The Wall Street Journal. “Do they want to do everything they can?”

But both groups had similar rates of 10-year survival (81%) and cancer progressing to metastatic breast cancer, which means the cancer has spread to other parts of the body such as the bones, liver or lungs.

“This is a very important validation that will have people saying, ‘Hey, we’ll be fine without radiation,'” said Dana-Farber Cancer Institute breast cancer specialist Harold Burstein, MD, PhD. Log. “This will allow clinicians to spare more and more women.”