Use of Post-Lumpectomy Radiation Therapy in Older Patients
While some research indicates women over 70 with early-stage breast cancer receive limited benefits from post-lumpectomy radiation, other studies demonstrate benefits for all patients, suggesting that radiation therapy is an integral part of breast conservation therapy for women of all ages. Radiation oncologist John K. Hayes, Jr., MS, MD, shares his views on the topic, including why the reduced risk of recurrence is clinically significant in this subgroup of patients, particularly as more targeted forms of treatment reduce the complications and inconvenience associated with radiation therapy.
One study notes a 6-7% reduction in local recurrence for patients who received tamoxifen and radiation therapy compared to those who received tamoxifen alone. Even if this is not statistically significant, can this decrease still be considered clinically significant?
As long as an adjuvant treatment is relatively safe in terms of adverse effects, as this intergroup trial showed, then I think this decrease can still be considered to be clinically significant. If the adjuvant treatment becomes safer, less costly and more convenient, the argument for treatment becomes even stronger.
“I think it is necessary for these women to discuss the issues with a radiation oncologist. The preponderance of evidence over the years shows a benefit from radiation in breast conservation therapy.”
What criteria do you use to determine which patients can safely omit radiation therapy?
There is no measured way to determine who will benefit from radiation therapy and who will not. A patient—after a discussion of pros and cons, costs, inconveniences and adverse effects of the adjuvant treatment—needs to feel empowered to make this decision for herself. That said, I would feel more comfortable in the omission of radiation in widely excised, small tumors or in women whose prospect of longevity, based on comorbid features, is not good.