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Radiation after lumpectomy unneeded in older women
Source: (cancerfacts.com)
Thursday, September 02, 2004
BOSTON – Sept. 2, 2004 – Older women treated with tamoxifen after breast-conserving surgery to remove early-stage breast cancer may safely forgo radiation therapy and its unpleasant side effects according to a new study.
Investigators from several major cancer research groups led by Dr. Kevin Hughes of Massachusetts General Hospital Cancer Center report that adding radiation to post-surgical tamoxifen treatment of women age 70 or older does not improve survival, has minimal impact on the risk of local tumor recurrence and does not prevent the need for eventual mastectomy. The study appears in today's New England Journal of Medicine.
"If a patient does not need to have radiation therapy, her quality of life can improve significantly," Hughes said in a prepared statement. "By showing that radiation therapy has very little impact on outcome for these patients, we can help each woman and her physician decide on the right treatment."
Over a five-year period, more than 600 patients age 70 or older with early-stage breast cancer at almost 30 centers across the U.S. enrolled in the study. All the participants had receptor-positive tumors and underwent lumpectomy surgery to remove the tumor, as opposed to complete removal of the breast, or mastectomy. Receptor positive tumors are those that have the protein that allows the cancer cells to use estrogen to spur growth. Tamoxifen blocks the effects of estrogen on tumor growth.
Patients were randomly assigned to receive either tamoxifen alone or tamoxifen plus radiation after surgery. At the end of the study period, the only significant difference between the groups was in the risk that the tumor would recur at or near its original site. Both groups had very low rates of recurrence; but while those in the tamoxifen-only group had a 4 percent risk, those who also received radiation had an only 1 percent risk.
There were no significant differences in terms of distant spread (metastasis) of the cancer, the need for mastectomy after recurrence or overall survival. Both groups had exactly the same number of breast cancer deaths – three in each group, a rate that reflects the less aggressive nature of breast cancer in this age group. As expected, those receiving radiation reported more pain, swelling, stiffness and other side effects than did the tamoxifen-only participants.
Radiation has been a standard post-surgical treatment for women having lumpectomies, but the therapy can both extend the treatment period and carry unpleasant side effects such as pain, swelling, and skin discoloration. Several studies have shown that, although radiation reduces tumor recurrence, it does not improve overall survival. Because breast cancer is less likely to recur in older women, the research team investigated whether such patients might do well if they receive tamoxifen alone after surgery.
"The local recurrence risk in both groups was extremely low, and women who have not had radiation have the option of another lumpectomy if they do have recurrence in the same breast. Once a patient has had radiation, however, she must have a mastectomy if her tumor recurs," says Hughes, an assistant professor of surgery at Harvard Medical School.
"In the long run, each woman and her physician should choose a treatment plan by weighing the slightly increased local recurrence risk against the virtually certain costs of radiation – the patient's time, adverse effects, and financial costs," he said.
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