Recent research published in the New England Journal of Medicine raises significant questions about the use of radiation therapy in certain breast cancer patients. The study reveals that for women with early-stage breast cancer, radiation treatment may not improve survival rates when combined with lymph node surgery and mastectomy, challenging long-held treatment practices.
The study focused on 1,600 women diagnosed with Stage II breast cancer, examining those with affected lymph nodes as well as aggressive tumors without lymph node involvement. After a follow-up period of 10 years, the findings indicated that only 29 patients experienced a recurrence of cancer in the chest area, regardless of whether they received radiation therapy or not. This suggests that radiation may be unnecessary for many patients in similar circumstances.
“This is an important trial in the management of breast cancer patients,” stated Dr. Chirag Shah, Department Chair of Radiation Oncology at the Allegheny Health Network Cancer Institute. He emphasized that the results could redefine the standard of care for appropriately selected patients. Nonetheless, he noted a significant limitation of the study: most participants underwent axillary lymph node dissections, which could diminish the perceived benefits of radiation in modern treatment approaches.
In this research, participants were divided into two groups—one that received radiation therapy following surgery and another that did not. Both groups exhibited nearly identical survival rates of 81% after ten years. While the study effectively demonstrated survival outcomes, it did not clarify whether radiation prevented cancer recurrence or metastasis.
Radiation therapy works by directing high-energy beams to damage the DNA of cancer cells. Although effective in halting tumor growth, it can also adversely affect healthy cells. Doctors have traditionally relied on chemotherapy and radiation based on previous studies that highlighted their efficacy. “Previous randomized trials showed not only a reduction in recurrence but also an improvement in survival rates when radiation followed mastectomy,” Dr. Shah explained.
The treatment can pose both short-term and long-term side effects. Short-term effects may include fatigue and skin irritation, while long-term consequences might encompass changes to the skin, lymphedema, and, in rare instances, the occurrence of a second cancer. Advances in radiation techniques have mitigated some of these risks, but they remain a consideration in treatment decisions.
According to the American Cancer Society, breast cancer is the most prevalent cancer among women in the United States, following skin cancer. Approximately 1 in 8 women, or around 13%, will be diagnosed with invasive breast cancer in their lifetime. Enhanced radiation treatments and targeted therapies have shortened treatment durations, allowing for a more tailored approach. Physicians are increasingly reconsidering radiation for women classified as low-risk for recurrence or metastasis.
While this recent study suggests that some women with intermediate risk might safely forgo radiation, Dr. Shah cautions that it remains critical for those at higher risk. He stated, “For patients who meet the trial eligibility criteria, it is important to inform them that radiation therapy has not been shown to improve survival, though there may be a higher risk of chest wall recurrences.” He also highlighted that women without lymph node dissection may still require radiation based on findings from other clinical trials.
Ultimately, shared decision-making between patients and their oncologists is crucial in determining the most appropriate treatment path. As clinical practices evolve, ongoing research will continue to shape the landscape of breast cancer treatment, focusing on both efficacy and quality of life for patients.
