Recent research published in the New England Journal of Medicine has raised significant questions about the necessity of radiation therapy for certain breast cancer patients. The study indicates that radiation may not be beneficial for some women with early-stage breast cancer who have undergone lymph node surgery and mastectomy, as no difference in survival rates was observed among those treated with radiation compared to those who were not.
The investigation involved a long-term follow-up of 1,600 women diagnosed with Stage II breast cancer, specifically focusing on patients at intermediate risk. These patients either had affected lymph nodes or aggressive tumors without lymph node involvement. Over a period of 10 years, only 29 women experienced recurrent cancer in the chest area, even without receiving radiation therapy.
“This is an important trial in the management of breast cancer patients,” stated Dr. Chirag Shah, Chair of Radiation Oncology at the Allegheny Health Network Cancer Institute. He emphasized that the findings could redefine the standard of care for appropriately selected patients. However, Dr. Shah highlighted a limitation of the study, noting that most participants underwent axillary lymph node dissections, which could influence the effectiveness of radiation and may not reflect current treatment practices.
In the study, participants were divided into two groups: one received radiation after surgery, while the other did not. After a decade, both groups exhibited nearly identical survival rates of 81%. While survival rates remained consistent, the study did not determine whether radiation therapy prevented cancer recurrence or the spread of the disease to other areas of the body.
Radiation therapy aims to target cancerous tumors using high-energy beams to damage the DNA of cancer cells, inhibiting their growth. Although radiation can affect healthy cells, advancements in techniques have reduced associated risks. Dr. Shah noted that while traditional studies have shown benefits from radiation therapy, including reduced recurrence and improved survival, the landscape of breast cancer treatment is evolving.
“Short-term side effects can include fatigue and skin irritation, while long-term effects may involve skin changes and lymphedema,” explained Dr. Shah. He also pointed out that radiation might complicate breast reconstruction efforts. The American Cancer Society reports that breast cancer is the most common cancer among women in the United States, with approximately 1 in 8 women diagnosed with invasive breast cancer during their lifetime.
Recent advancements in radiation technology and targeted therapies have led to shorter treatment durations, prompting healthcare professionals to reconsider radiation for women with low risk of recurrence or metastasis. Although this study suggests that some women at intermediate risk may forgo radiation, experts assert that it remains critical for patients at higher risk.
“My takeaway is that patients who fit the trial criteria should be informed that radiation therapy does not improve survival, though there may be an increased risk of chest wall recurrences,” Dr. Shah advised. He also noted that women who do not undergo lymph node dissection might still require radiation based on other clinical trial findings. Ultimately, the emphasis lies on shared decision-making between patients and their oncologists, ensuring that treatment plans are tailored to individual circumstances.
