Older Breast Cancer Patients May Not Need Radiotherapy

Breast cancer radiotherapy can usually be avoided in patients 65 and older

(RxWiki News) Breast cancer in older women behaves differently than it does in younger women. Breast cancer is less likely to return in older women. So older women can be treated differently, too, a new study suggests.

Women aged 65 and older generally do not need radiotherapy to treat their hormone-sensitive breast cancer, according to this new trial.

The study found that radiation would be an unnecessary treatment in 95 out of 100 women in this age group because five-year recurrence rates are quite low — about 5 percent.

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The lead investigator of this phase lll trial known as PRIME2 was Ian Kunkler, FRCR, professor of clinical oncology at the Edinburgh Cancer Research Center in the University of Edinburgh.

The aim of the trial was to see if older breast cancer patients could safely forego whole-breast radiation. The researchers evaluated the results based on the rates of recurrence seen in the same breast — which is called ipsilateral breast tumor recurrence (IBTR).

The trial enrolled 1,326 breast cancer patients aged 65 and older between 2003 and 2009 who were randomly assigned either to receive radiation treatment or not.

The cancers were not aggressive or hormone-driven and had not spread to the lymph nodes in all participants. The women received therapy following surgery to block production of hormones that drove their cancers.

After five years of follow-up, the researchers found the following:

  • 1.3 percent of women who received radiotherapy had a a recurrence in the same breast, compared to 4.1 percent of patients who did not have radiation treatment.
  • Overall survival was essentially the same — 97 percent for treated patients and 96.4 percent for women who did not receive radiation.
  • Regional recurrence and recurrence in the opposite breast were well below 1 percent in both groups.
  • Cancer-free survival — the period during which no cancer was evident — was 98.5 percent for those who received radiotherapy and 96.4 for those who weren’t treated with radiation.

Brian D. Lawenda, MD, National Director of Integrative Oncology and Cancer Survivorship at 21st Century Oncology and Founder of IntegrativeOncology-Essentials.com, said these results confirm what most radiation oncologists already know.

“We also know from previously reported studies that for this same population of 'low risk' patients who do not receive radiation therapy, their risk of recurrence continues to go up each year more quickly than those who receive radiation therapy. For patients who are generally in good health and have a long expected longevity this increased risk can climb significantly over the years and often tips the scales in favor of recommending radiation therapy to reduce this risk," Dr. Lawenda said.

"It is important to have a discussion about these factors with a radiation oncologist,” Dr. Lawenda continued, “so they can help you develop a treatment plan based on your pathology, age, other medical conditions, overall health status and your feelings about the various treatments and potential side effects."

Findings from the PRIME 2 trial were presented at the 2013 San Antonio Breast Cancer Symposium. Research is considered preliminary before it’s published in a peer-reviewed journal.

This study was funded by the Chief Scientist's Office for Scotland. Dr. Kunkler declared no conflicts of interest.

Review Date: 
December 11, 2013