Up to two-thirds of older women with early-stage breast cancer may be receiving radiation therapy that may not provide additional benefit. These findings were recently released online by the journal Cancer.
The goal of radiation therapy in early breast cancer is to kill cancer cells that could otherwise remain after therapy and cause a recurrence. Studies have shown that patients with node-negative Stage I breast cancers who are treated with breast-conserving surgery (lumpectomy) and receive additional treatment with radiation therapy have improved outcomes. Patients who do not receive radiation after lumpectomy may be more likely to experience cancer recurrence. Based on recent findings, however, some researchers are questioning whether radiation is beneficial for all early breast cancer patients.
Findings suggest that women over age 70 who have Stage I estrogen-receptor positive breast cancer may not benefit from the addition of radiation therapy. According to a Phase III study, the Cancer and Leukemia Group B (CALGB) 9343 trial, these older patients might do just as well with lumpectomy and additional therapy with tamoxifen alone, rather than both tamoxifen and radiotherapy.
Researchers recently used data from the Surveillance, Epidemiology, and End Results (SEER) registry to assess the frequency of radiation therapy in addition to lumpectomy in older early-stage breast cancer patients. Researchers identified just over 40,000 women age 70 or older who underwent lumpectomy for early-stage breast cancer between 2000 and 2009. They assessed frequency radiation in addition to surgery among these women.
Among patients treated between 2000 and 2004, 69% received radiation in addition to lumpectomy, and 62% of those treated between 2005 and 2009 received additional radiation. Forms of radiation therapy included external beam, where radiation comes from a machine outside the body and is focused on the cancer, and implant radiation, where sources of radiation are put into or near the area that needs treatment. Use of implant radiation increased from just over 1% of patients between 2000 and 2004 to just over 6% between 2005 and 2009; the use of external radiation declined during this period. Radiotherapy in both forms was delivered less frequently over the course of the study.
The researchers concluded that while data from the CALGB trial indicated that radiation in addition to lumpectomy didn’t contribute to better outcomes for older women with early-stage breast cancer, many of these women continue to receive radiation. And while these researchers have observed a decrease in the amount of women receiving additional radiation, according to their findings, nearly two-thirds of older women continue to receive radiation that may not improve their outcomes over treatment with surgery and tamoxifen alone.
These findings are important for patient care because, when effective, less aggressive treatments can help patients avoid side effects and unnecessary cost.
 Palta M, Palta P, Bhavsar NA, et al. The Use of Adjuvant Radiotherapy in Elderly Patients with Early-Stage Breast Cancer: Changes in Practice Patterns after Publication of Cancer and Leukemia Group B 9343. Cancer [early online publication]. December 8, 2014.
 Hughes KS, Schnaper LA, Bellon JR, et al. Lumpectomy Plus Tamoxifen With or Without Irradiation in Women Age 70 Years or Older With Early Breast Cancer: Long-Term Follow-Up of CALGB 9343. Journal of Clinical Oncology. 2013 Jul 1;31(19):2382-7. doi: 10.1200/JCO.2012.45.2615.
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