Omitting radiation therapy after breast-conserving surgery may not impact 10-year survival rates for older patients with HR-positive breast cancer

December 09, 2020

SAN ANTONIO - Older patients with hormone receptor-positive breast cancer who did not receive radiation therapy after breast-conserving surgery had higher rates of local recurrence but similar 10-year survival rates when compared to patients who received postoperative radiation therapy, according to updated 10-year data from the PRIME II study, presented at the 2020 San Antonio Breast Cancer Symposium, held Dec. 8-11.

"Over half the patients diagnosed with breast cancer in developed countries are over the age of 65 years," said Ian Kunkler, FRCPE, professor of clinical oncology at the Western General Hospital, University of Edinburgh. Despite the less aggressive breast cancers typically diagnosed in this population, most patients who undergo breast-conserving surgery continue to be treated with whole breast radiation therapy after surgery, he explained. "We were interested in determining whether older patients with low-risk breast cancer could be spared radiation therapy."

The PRIME II study enrolled 1,326 patients with non-metastatic hormone receptor (HR)-positive breast cancer. All patients were at least 65 years of age, had undergone breast-conserving surgery, and were receiving adjuvant hormone therapy. Patients were randomly assigned to either receive or not receive radiation therapy after surgery. Kunkler and colleagues previously reported greater rates of local recurrence (defined as recurrence in the same breast as the primary tumor) in patients who did not receive radiation therapy, but no significant differences in overall survival, distant metastases, or new breast cancers between the two arms after five years.

The latest data presented at the symposium report results from a 10-year follow-up. Kunkler reported that the rate of local recurrence after 10 years was significantly greater in patients who did not receive radiation therapy compared with patients who did (9.8 percent vs. 0.9 percent).

While postoperative radiation therapy affected the risk of local recurrence, it did not significantly impact certain other clinical outcomes. After 10 years, patients who did not receive radiation therapy had similar rates of distant metastasis (1.4 percent vs. 3.6 percent), recurrence in the opposite breast (1.0 percent vs. 2.2 percent), and overall survival (80.4 percent vs. 81.0 percent) as patients who did receive radiation therapy. Most deaths were due to reasons other than breast cancer.

"We found that omitting postoperative radiation therapy did not compromise survival or increase the risk of distant metastasis," said Kunkler. "Based on these results, we believe that omission of radiation therapy after breast-conserving surgery should be an option for older patients with localized, HR-positive breast cancer who are receiving adjuvant hormone therapy and meet certain clinico-pathological criteria."

A limitation of the study is that only a few patients with grade 3 tumors were recruited, so the results of the study may not be applicable to patients with high-grade tumors or with tumors larger than 3 centimeters. An additional limitation is that data on comorbidities or adherence to adjuvant hormone therapy were not collected.
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The study was supported by the Chief Scientist Office for Scotland and the Edinburgh Breast Cancer Institute NHS Endowment Fund. Kunkler declares no conflicts of interest.

About the San Antonio Breast Cancer Symposium

Since 1977, the San Antonio Breast Cancer Symposium® (SABCS®) has been the leading scientific conference for basic scientists, physician-scientists, clinical investigators and breast care providers, and advocates seeking an exchange of new information in experimental biology, etiology, prevention, diagnosis, and therapy of premalignant breast disease and breast cancer. Founded, owned, and operated by UT Health San Antonio, the symposium has grown to a five-day event attended by an international audience of academic investigators and private physicians from over 80 countries to attain information through abstract presentations, panel discussions, research findings, and state-of-the-art educational sessions. UT Health San Antonio, with co-sponsors the Dan L Duncan Comprehensive Cancer Center at Baylor College of Medicine and the American Association for Cancer Research, supports SABCS, which provides education and accessibility to the latest information regarding the prevention, diagnosis, and treatment of premalignant breast cancer and breast disease. For more information on SABCS, visit http://www.sabcs.org.

To interview Ian Kunkler, please contact Julia Gunther at julia.gunther@aacr.org or 770-403-7690.

American Association for Cancer Research

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