Following Breast Conserving Surgery -What Subgroup of Patients Can Have Omission of Adjuvant Irradiation?

• Multiple groups have attempted to define a favorable subgroup of women in whom the omission of adjuvant irradiation following a partial mastectomy is reasonable:The CALGB 9343 trial:Randomized women:Ages 70 years and older
  • • • With clinical stage I (T1,N0,M0) disease:To tamoxifen for 5 years versus tamoxifen plus whole-breast irradiationPatients with estrogen receptor-negative tumors were excluded
        • Most tumors were 2 cm or less
        • Surgical margins were required to be negative:Defined as the absence of tumor at the inked margin
    • Adjuvant whole-breast irradiation:Significantly reduced the risk of local or regional failure:From 10% to 2% at 10 yearsThere were no significant differences in:Distant disease-free survival or overall survival between the groups
  • The PRIME II trial:Enrolled 1326 patients:Ages 65 years and older
    • • T1 to T2
      • Node-negative tumors
      • Clear margins
    • Following breast-conserving surgery:Patients received endocrine therapyAnd were randomized to adjuvant radiation therapy or no further treatment
    • At 5 years:Those undergoing radiation:Demonstrated a reduction in local recurrence:4.1% vs 1.3%
      • • With no difference in survival
• Typical breast tangents:Without targeted nodal irradiation:Would be appropriate for a patient with pN0 disease
• Adjuvant irradiation reduces the risk of ipsilateral breast tumor recurrence regardless of whether the margins are positive:A positive margin:Significantly increases the risk of local failure despite irradiation

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