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Can Some Women Skip Radiotherapy After Breast Conserving Surgery?

Reuters Health • The Doctor's Channel Newscast

By Megan Brooks

NEW YORK (Reuters Health) – Radiation may be unnecessary for some women with early-stage breast cancer after conservative surgery, according to preliminary data from a randomized controlled study from Italy.

The study, led by Dr. Corrado Tinterri of Humanitas Cancer Center in Milan, found no statistically significant difference in the risk of local recurrence and overall survival between women who did and did not receive radiotherapy after surgery.

The women were between 55 and 75 years old and had a maximal tumor size of 2.5 cm, without an extensive intraductal component and without peri-tumoral vascular invasion.

Dr. Tinterri reported the findings May 2 at the American Society of Breast Surgeons (ASBrS) annual meeting in Chicago.

Breast conserving surgery with post-surgical whole breast irradiation (WBI) is the generally accepted treatment for women with early-stage breast cancer, Dr. Tinterri noted at a media briefing. The question of whether postoperative WBI is mandatory in all patients remains a controversial issue in breast conserving therapy, he said.

Dr. Tinterri reported data on 749 women with early breast cancer who underwent breast conserving surgery with WBI (n=373) or without WBI (n=376).

After a median follow-up of 108 months, there is no statistically significant difference between the two groups in local and distant relapse rates, Dr. Tinterri said.

Twelve women who received radiation (3.4%) experienced a local recurrence as did 16 women who did not receive radiation (4.4%). Distant relapse occurred in 26 women who received radiation (6.9%) and 28 women who did not (7.5%).

Importantly, Dr. Tinterri said, after 108 months, “the overall survival is the same.” Fifty-one women who received radiation and 53 who did not died during follow-up.

“So maybe these data indicate that breast radiation after conservative surgery might be avoided in selected patients with early breast cancer aged 55 to 75 years without increased risk of local and distant disease recurrences,” Dr. Tinterri said.

However, the data are “preliminary and longer follow up is needed,” he emphasized.

If radiotherapy could be omitted in select patients, it would mean reduced costs, fewer complications and “better quality of life for the patient and earlier return to work or active life,” he said.

Dr. Deanna Attai, ASBrS board member and director the Center for Breast Care, Inc. in Burbank, California, who moderated the briefing, said, “Whether it’s in Italy or this country, we are obviously always looking for ways to reduce complication rates and look for areas of cost savings without compromising the oncologic quality for the patient and this study is very interesting and I look forward to seeing more data as it matures.”