Radiation Not Always Needed for Breast Cancer Patients

Radiation still given with tamoxifen and surgery to treat breast cancer in older women, despite evidence that it may not be more effective

(RxWiki News) Radiation may not always be necessary to treat breast cancer — but some patients were still receiving it, along with two other treatments that worked just as well without radiation.

A new study found that most elderly women with early breast cancer received radiation along with hormone therapy and surgery.

Past studies found that radiation treatment may not affect how often breast cancer recurs in older women if they receive surgery and hormone therapy as well, the authors of the current study noted. Still, many women received all three treatments.

"Our findings highlight the fact that it may be challenging for practitioners to incorporate clinical trial data that involves omitting [radiation, which] was previously considered standard of care," said study author Rachel Blitzblau, MD, PhD, of Duke University in Durham, NC, in a press release.

"It has been found that the triad of treatments given to patients with early stage breast cancer — lumpectomy, radiation treatments and hormonal therapy — are not always all necessary in the elderly population," said Alexis Harvey, MD, Medical Director for the New Jersey Region of 21st Century Oncology.

"Depending on the performance status of the patient, it is possible to eliminate the radiation treatments and possibly the hormonal treatments, too. If the patient has an estimated survival of more than 5 years, it is quite often beneficial to give the treatments. If, however, there are many medical issues, it is reasonable to eliminate the daily radiation, and it will not have any impact on their survival," said Dr. Harvey, who was not involved in this study.

"If, however, the patient has a good performance status and wants all treatment, then it is reasonable to treat, possibly with a shorter course than the standard 6-7 weeks," she said. "Each patient is evaluated on an individual basis."

A past study — called the Cancer and Leukemia Group B (CALGB) study — found that female breast cancer patients aged 70 and older who were treated with lumpectomy and a breast cancer medication called tamoxifen (brand names Soltamox and Nolvadex) had about the same rate of cancer recurrence (4 percent) as women who also had radiation treatments (1 percent). A lumpectomy is a procedure in which a surgeon removes a breast cancer tumor but not the whole breast. Tamoxifen is a medication used to treat breast cancer tumors that have certain proteins called estrogen receptors on their surface.

Ten years later, there was no difference in survival between the women who received lumpectomy and tamoxifen and those who received the surgery, medication and radiation. In other words, the CALGB study found radiation may not be a necessary treatment for some older breast cancer patients.

Dr. Blitzblau and colleagues looked at whether women's early-stage cancer was treated differently based on the findings of the CALGB study.

Early breast cancer was defined as having a cancer tumor that was less than or equal to 2 centimeters in size and had not spread.

Dr. Blitzblau and team looked at how often radiation was given to elderly women along with surgery and tamoxifen between 2005 and 2009. They compared this frequency with that of the years 2000 to 2004. Results of the CALGB study were published in 2004.

These researchers found a small decrease in the use of radiation in these women during 2005 to 2009 — compared to the years before the CALGB findings. Before the CALGB study was published, about 69 percent of these older breast cancer patients received radiation. Between 2005 and 2009, about 62 percent received it.

Despite the decrease in use of radiation, many women over 70 with early breast cancer still received radiation as a breast cancer treatment.

Dr. Blitzblau and team said too much treatment can be hard on older patients' health. Leaving radiation out of treatment when possible could improve patients' treatment.

These researchers called for more educational materials to help patients make decisions about their cancer treatment.

This study was published online Dec. 8 in Cancer.

The authors disclosed no funding sources or conflicts of interest.

Review Date: 
December 5, 2014