Radiation Following Lumpectomy in Early-Stage Breast Cancer Reduces Recurrences
According to a recent article published in The New England Journal of Medicine , radiation following lumpectomy and hormone therapy reduces the risk of a cancer recurrence in women ages 50 and older. This risk appears greatest in women aged 50 to 59 years.
Breast cancer is a common type of cancer among women in the United States, with approximately 250,000 women being diagnosed with the disease annually. Patients who are diagnosed with small breast cancers that are confined to the site of origin have a high cure rate following standard treatment. Standard treatment for early breast cancer often includes the removal of the cancer (lumpectomy) followed by radiation therapy to the breast. Chemotherapy and/or hormone therapy may also be part of the standard treatment regimen in early breast cancer according to disease and patient characteristics. Several clinical studies have documented the effectiveness of the addition of radiation therapy to patients with early-stage breast cancer; however, results involving elderly patients are limited. A recent report published in The New England Journal of Medicine indicated that women who are 70 years or older with early-stage, hormone-positive breast cancer who are treated with a lumpectomy and hormone therapy do not appear to gain a benefit from breast radiation.
Hormone-positive breast cancer, also called estrogen or progesterone receptor-positive breast cancer, refers to cancer that is stimulated to grow through exposure to naturally occurring female hormones such as estrogen or progesterone. A large portion of breast cancers are considered hormone positive, and these patients have an option to be treated with hormone therapy. Hormone therapy reduces or mitigates the amount of female hormones that are able to reach cancer cells, thus inhibiting the growth stimulus of cancer.
Researchers from Canada recently conducted a clinical trial to further evaluate the addition of radiation to lumpectomy and hormone therapy in women with early, hormone-positive breast cancer. This trial included 636 women who were aged 50 years or older. All were treated with a lumpectomy plus the hormone therapy agent tamoxifen (Nolvadex®). Approximately half of the patients were also treated with radiation therapy to the breast, while the other half did not receive radiation therapy. Overall, at 5 years, cancer-free survival was 91% for women treated with radiation, compared with 86% for those not treated with radiation. Cancer recurrences within the breast at 8 years were only 3.5% for those treated with radiation, compared with 17.6% for those not treated with radiation. However, upon subgroup analysis, the greatest risk of a cancer relapse within the breast was among women who were aged 50-59 years. Overall, women who were 60 years or older had a significantly decreased risk of a cancer relapse within the breast compared to their younger counterparts. Women who were 60 years or older with a cancer that was 1 centimeter or smaller in size had nearly identical rates of breast cancer relapses whether or not they were treated with radiation therapy. There was no subgroup analysis that evaluated the group of women who were 70 years or older.
The researchers concluded that the addition of radiation to lumpectomy and tamoxifen reduces the risk of a cancer relapse in women 50 years or older with hormone-positive, early breast cancers. However, the additive benefit of radiation therapy was significantly reduced in women ages 60 years or older, particularly in those with smaller cancers. These results add to a growing number of trial results that should prompt patients, particularly elderly patients to ask their physician about their individual risks and benefits of treatment with radiation therapy with lumpectomy and hormone therapy.
 Fyles AW, McCready DR, Manchul LA, et al. Tamoxifen with or without breast irradiation in women 50 years of age or older with early breast cancer. New England Journal of Medicine. 2004;351:963-970.
 Hughes KS, Schnaper LA, Berry D, et al. Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer. New England Journal of Medicine. 2004;351:971-977.