According to results recently published in the Journal of the National Cancer Institute, the addition of radiation improves cancer-free and overall survival in women with node-positive breast cancer.

Breast cancer is diagnosed in over 200,000 women annually in the United States alone. Patients with early breast cancer, or cancer that has not spread to distant sites in the body, can achieve high rates of long-term survival with standard therapy. Standard therapy for early breast cancer includes surgical removal of the cancer, chemotherapy, hormone therapy, and/or radiation therapy. Women whose cancer is larger than 5 cm and those who have cancer spread to 4 or more axillary (under the arm) lymph nodes are considered to be at a higher risk of developing a cancer recurrence than their counterparts. Consensus guidelines indicate that women with these risk factors should undergo radiation in their treatment regimen. However, there has been controversy as to whether women with early breast cancer who are not considered to be at a high risk of developing a cancer recurrence (small cancer size and cancer spread to 3 or fewer axillary lymph nodes) benefit from the addition of radiation to their treatment regimen.

Researchers affiliated with the British Columbia radiation randomized trial have recently reported 20-year follow-up results regarding the use of radiation therapy in early breast cancer. This trial included 318 women with early, node-positive (cancer spread to axillary lymph nodes) breast cancer. All patients were treated with a mastectomy, plus chemotherapy consisting of cyclophosphamide, methotrexate, 5-fluorouracil (CMF). Approximately half of the patients received radiation therapy as part of their treatment regimen and the other half did not. At 20 years, cancer-free survival and overall survival were significantly improved in the group of women who had received radiation, compared to those who had not received radiation. Cancer-free survival was 48% for those who received radiation, compared to 30% for those who did not receive radiation. Overall survival was 47% in the group that received radiation therapy, compared to 37% in the group that did not receive radiation therapy. Patients who were considered to be at a low risk of developing a cancer recurrence demonstrated a benefit from radiation therapy consistent with those who were considered to be at a high risk of developing a recurrence.

The researchers concluded that the addition of radiation therapy to treatment including surgery and chemotherapy for patients with early breast cancer appears to improve long-term cancer-free and overall survival. However, with the current use of more aggressive chemotherapy regimens (compared to the one used in this trial), the definitive role of radiation therapy remains inconclusive for patients considered to be a low-risk of developing a recurrence. It is important for patients with early breast cancer to discuss all treatment options with their physicians to determine individual risks and benefits of each treatment option.

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Reference: Ragaz JR, Olivotto IA, Spinelli JJ, et al. Locoregional radiation therapy in patients with high risk breast cancer receiving adjuvant chemotherapy: 20-year results of the British Columbia Randomized Trial. Journal of the National Cancer Institute. 2005;97:116-126

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