Breast cancer: Radiation may not affect survival in certain patients over 65, new study suggests

CNN
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For some older breast cancer patients, skipping radiation therapy after surgery does not appear to adversely affect overall survival, according to a new study.

Skipping radiation therapy after surgery may not affect overall survival in women aged 65 and older with small, hormone-positive breast cancer tumors after 5 years of endocrine therapy, study says . New England Journal of MedicineHowever, it may increase the risk that the cancer will return in the same breast.

The findings suggest that side effects such as fatigue, hair loss, breast pain, and the risk of heart and lung complications may result in longer overall survival in this group as long as they receive endocrine therapy. It suggests that radiation may not be necessary. . endocrine therapy – Also called hormone therapy, which involves adding, blocking, or removing hormones as part of a therapeutic approach for certain conditions, such as slowing or stopping the growth of certain cancers.

Dr. Alice Ho of Duke University School of Medicine and Dr. Jennifer Beron of Harvard Medical School wrote in an editorial Published with new research.

“The ability to omit radiation therapy is one of many options in a long list of options such as omitting radiation therapy and reducing target volume,” Ho and Bellon wrote. “Realistically speaking, radiotherapy can be time and financially stressful. Therefore, we welcome solid data that would solidify the option of skipping radiotherapy in selected patients.”

The study included data on 1,326 women with breast cancer aged 65 and older. From April 16, 2003 to her December 22, 2009, 658 women were randomly assigned to receive radiation therapy to the whole breast, of whom 668 of her did not receive radiation therapy. . The trial was conducted at 76 centers in the UK, Greece, Australia and Serbia.

The researchers found that cancer recurrence in the same breast was more common in participants who did not receive radiation. The cumulative incidence of local recurrence was 9.5% in the non-radiation group and 0.9% in the radiation group.

“The incidence of local recurrence by 10 years remained low in patients who received radiotherapy, whereas the incidence continued to increase in patients who did not receive radiotherapy, and there was no apparent plateau. However, 10 years Absolute differences in local recurrence rates between years were small,” researchers at the University of Edinburgh and Western General Hospital in Scotland wrote in their study.

Overall survival at 10 years was also similar, 80.8% without radiotherapy and 80.7% with radiotherapy. There were 16 deaths from breast cancer in the nonradiation group and 15 in the radiotherapy group.

While previous studies favored excluding radiation in women with small tumors (less than 2 cm) over 70 years of age, this new study lowers the age limit to 65 years, with tumors of up to 3 cm. It provides evidence for the inclusion of women with tumors, said Dr. Naamit Kurshan Gerber. She is a radiation oncologist at NYU Langone Perlmutter Cancer Center in New York and was not involved in the study.

In the United States, 26% of breast cancer diagnoses are in women aged 65 to 74, according to this study.

“Prior to this paper, there was evidence that additional radiation reduced the risk of local recurrence in women aged 70 and older, but did not alter survival. And this study highlights the importance of that evidence.” “The role of radiation in these women really reduces the risk of this local recurrence, but it actually reduces the overall survival rate.” does not affect the

Some breast cancer patients may decide to skip radiotherapy for various reasons, such as side effects, but choose to receive radiotherapy to reduce the risk of cancer recurring in the same area. Some people

But Gerber added that skipping radiation is not an option for breast cancer patients who do not plan to receive endocrine therapy.

For physicians and patients, “it’s very important to engage in shared decision-making about your values, what your goals are, and what the risks and benefits of radiotherapy will be to relapse,” Gerber said. said.

“There are risks and side effects, but it’s always a very nuanced debate,” she said.