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Skipping radiation therapy for breast cancer may not affect 10-year survival, but one radiation oncologist suggests patient noncompliance with endocrine therapy is the real reason for reduced benefits.
Patients with breast cancer who were treated with radiation therapy saw a benefit in reduced recurrence for the first 10 years after treatment, but overall survival 10 years later was “almost identical” to patients who skipped radiation, according to a recent study.
However, one expert highlighted the importance of patients following their prescribed regimen for the best possible outcome. In his opinion, patients should not forego radiation therapy just yet — especially without discussing it with their health care team.
The study, published in the New England Journal of Medicine, analyzed 1,326 patients: 658 women were randomly assigned to receive whole-breast irradiation (meaning that the whole breast is being treated with, and absorbing radiation) and 668 received no radiation therapy.
Within 10 years of ending treatment, patients who received radiation therapy saw a local recurrence rate (which, according to the American Cancer Society means that the cancer came back in the same breast) of 0.9%, as opposed to 9.5% in the group who did not receive radiotherapy. Distant recurrence (meaning that breast cancer came back in another body part) was 1.6% in the group that did not receive radiation and 3% in the radiation group, as radiation only affects the area where a tumor is initially treated.
However, although there was a difference in local recurrence early on, the study authors reported similar rates of overall survival (percentage of patients who were still alive) 10 years after treatment, at 80.8% for those without radiation and 80.7% for those treated with radiation.
“Omission of radiotherapy was associated with an increased incidence of local recurrence but had no detrimental effect on distant recurrence as the first event or overall survival among women 65 years of age or older with low-risk, hormone receptor–positive early breast cancer,” the study authors concluded.
However, Joseph Panoff, a radiation oncologist specializing in breast cancer at the Baptist Health Miami Cancer Institute in Florida, expressed concerns about patients rejecting radiation oncology in light of these data:
“The media has picked up on this and the story that they're telling is you don't need radiation,” he said in an interview with CURE®. “But if you look deeper at that article and read it carefully, what you find is that 60 to 70% of those patients were not complying with endocrine therapy. When you're not complying with endocrine therapy, the risk of recurrence goes up four times — it's quadrupled. Additionally, in patients that have estrogen-low tumors, the recurrence is 20%, not 9%.”
Panoff was clear that while radiation therapy may not be the correct treatment course for all patients, some may reject radiation therapy out of misplaced concerns and a lack of education on the safety of modern radiation practices.
“What I'm concerned about is that a lot of patients, are not going to not be educated properly on this, they're going to not do radiation, and there's going to be a very high risk of recurrence that we're going to see in patients because they're non-compliant with endocrine therapy many years out.”
Panoff concluded by encouraging patients to stick to their care plans to keep risk of recurrence as low as possible.
“The message is, if you're not going to do radiation and you're above 65 years old, and you've talked with a radiation oncologist and medical oncologist, make sure you're compliant with five years of endocrine therapy, or else your risk of recurrence is going to be inappropriately high.”
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