Omission of radiotherapy after breast-conserving surgery for women with breast cancer with low clinical and genomic risk: 5-year outcomes of IDEA Journal Article
| Authors: | Jagsi, R.; Griffith, K. A.; Harris, E. E.; Wright, J. L.; Recht, A.; Taghian, A. G.; Lee, L. C. L.; Moran, M. S.; Small, W.; Johnstone, C.; Rahimi, A.; Freedman, G.; Muzaffar, M.; Haffty, B.; Horst, K.; Powell, S. N.; Sharp, J.; Sabel, M.; Schott, A.; El-Tamer, M. |
| Article Title: | Omission of radiotherapy after breast-conserving surgery for women with breast cancer with low clinical and genomic risk: 5-year outcomes of IDEA |
| Abstract: | PURPOSEMultiple studies have shown a low risk of ipsilateral breast events (IBEs) or other recurrences for selected patients age 65-70 years or older with stage I breast cancers treated with breast-conserving surgery (BCS) and endocrine therapy (ET) without adjuvant radiotherapy. We sought to evaluate whether younger postmenopausal patients could also be successfully treated without radiation therapy, adding a genomic assay to classic selection factors.METHODSPostmenopausal patients age 50-69 years with pT1N0 unifocal invasive breast cancer with margins >= 2 mm after BCS whose tumors were estrogen receptor-positive, progesterone receptor-positive, and human epidermal growth factor receptor 2-negative with Oncotype DX 21-gene recurrence score <= 18 were prospectively enrolled in a single-arm trial of radiotherapy omission if they consented to take at least 5 years of ET. The primary end point was the rate of locoregional recurrence 5 years after BCS.RESULTSBetween June 2015 and October 2018, 200 eligible patients were enrolled. Among the 186 patients with clinical follow-up of at least 56 months, overall and breast cancer-specific survival rates at 5 years were both 100%. The 5-year freedom from any recurrence was 99% (95% CI, 96 to 100). Crude rates of IBEs for the entire follow-up period for patients age 50-59 years and age 60-69 years were 3.3% (2/60) and 3.6% (5/140), respectively; crude rates of overall recurrence were 5.0% (3/60) and 3.6% (5/140), respectively.CONCLUSIONThis trial achieved a very low risk of recurrence using a genomic assay in combination with classic clinical and biologic features for treatment selection, including postmenopausal patients younger than 60 years. Long-term follow-up of this trial and others will help determine whether the option of avoiding initial radiotherapy can be offered to a broader group of women than current guidelines recommend. |
| Keywords: | recurrence; age; irradiation; tamoxifen; endocrine therapy; lumpectomy; follow-up; radiation-therapy; cohort; older |
| Journal Title: | Journal of Clinical Oncology |
| Volume: | 42 |
| Issue: | 4 |
| ISSN: | 0732-183X |
| Publisher: | American Society of Clinical Oncology |
| Date Published: | 2024-02-01 |
| Start Page: | 390 |
| End Page: | 398 |
| Language: | English |
| ACCESSION: | WOS:001233662300004 |
| DOI: | 10.1200/jco.23.02270 |
| PROVIDER: | wos |
| PUBMED: | 38060195 |
| PMCID: | PMC11846025 |
| Notes: | Source: Wos |
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