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Adjuvant RT essential for breast-conserving surgery patients

  Radiotherapy (RT) should be included routinely in the treatment of women with early-stage invasive breast cancer who undergo breast-conserving surgery (BCS), research published in the International Journal of Radiation Oncology Biology Physics confirms.

While study findings have demonstrated that BCS and adjuvant RT achieve a similar survival rate to mastectomy in patients with early breast cancer, the impact of RT on treatment success is unknown.


To investigate further, Jennifer Bellon (Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, Massachusetts, USA) and colleagues examined the outcome of 87 women with unicentric, T1, node-negative, invasive ductal, mucinous or tubular carcinoma without lymph vessel invasion.

The patients underwent BCS and achieved a margin of at least 1 cm or a negative margin on re-excision, but did not receive RT or systemic treatment.

Following-up the group for a median of 86 months, 23% of patients experienced local recurrence as first sign of failure, giving an average annual rate of local recurrence of 3.5 cases per 100 patient-years.

First failure also occurred in the ipsilateral axilla in one patient, as contralateral breast cancer in two patients, and as distant metastases in four cases.

Nine patients died during the study, including four deaths from metastatic breast cancer.

While noting that future risk-assessment profiling may allow the selection of patients most likely to recur in the absence of RT, the team says that the risk of local recurrence was "unacceptably high" in their patient group.

"The data do not support the routine omission of RT in healthy women with a reasonable life expectancy," Bellon et al write, suggesting that short RT courses or partial-breast RT may be possible in this population.

Nevertheless, they admit: "In women older than 70 years with serious comorbid illness and a limited life expectancy, however, hormonal therapy alone is a reasonable option."

Int J Rad Oncol Biol Physics 2006; 65: 11491154





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