A study conducted by UNM Cancer Research & Treatment Center Medical Oncologist Clair Verschraegen, M.D., and colleagues concluded that the omission of radiotherapy after breast-conserving surgery for early-stage breast cancer is associated with higher rates of relapse and a slightly higher mortality rate. The study appeared in the January 21 issue of the Journal of the National Cancer Institute.
Many studies have shown that women with early-stage breast cancer who have breast-conserving surgery followed by radiotherapy have similar survival rates as women who have a mastectomy, and those women are also spared the disfiguration of losing their breast. However, radiotherapy does prolong the length of time that women are treated for breast cancer; and the treatment can be costly, radiotherapy facilities are not common in all areas and there are some side effects to radiotherapy.
For these reasons, several studies have examined the consequences of omitting radiotherapy from the treatment regimen. Vincent Vinh-Hung, M.D., of the Oncology Center at Academic Hospital in Jette, Belgium, who worked with Verschraegen in the study, performed a pooled analysis of 15 randomized clinical trials of women with early-stage breast cancer who underwent breast-conserving surgery alone or surgery followed by radiotherapy. They analyzed recurrence rates based on information from 9,422 women, and mortality information was available for 8,206 women.
The authors calculated that the women who received breast-conserving surgery alone were three times more likely to have a relapse than women who had breast-conserving surgery followed by radiotherapy. (In clinical trials that had 5 or more years of follow-up information, the relapse rate ranged from 0.4% to 2.1% per year for women who received breast-conserving surgery and radiotherapy, compared with 1.4% to 5.7% per year among women who only had surgery.) The authors also calculated that the omission of radiotherapy resulted in an 8.6% relative excess of deaths.
"The present study confirms that radiotherapy should not be omitted after breast-conserving surgery, except for medical contraindications such as systemic vascular disease or a previous history of irradiation," Verschraegen said
The Journal of the National Cancer Institute is published by Oxford University Press and is not affiliated with the National Cancer Institute. Visit the Journal online at http://jncicancerspectrum.oupjournals.org/.
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