Younger Postmenopausal Patients May Skip Adjuvant Radiotherapy After Early Breast Cancer Surgery

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Younger postmenopausal patients with low-risk, stage I HR-positive breast cancer and certain genetic markers may be able to safely forgo adjuvant radiotherapy:
    • According to study findings presented at the 2023 San Antonio Breast Cancer Symposium in Texas
  • In the IDEA (Individualized Decisions for Endocrine therapy Alone) trial:
    • 200 postmenopausal patients with stage I HR-positive, HER2-negative breast cancer:
      • All of whom had scores of 18 or less on the Oncotype DX recurrence assay:
        • Elected to skip adjuvant radiotherapy:
          • Provided they were willing to continue with endocrine therapy for 5 years
    • All participants were aged between 50 and 69 years and required to have a margin of 2 mm or more after breast-conserving surgery
    • The primary outcome:
      • Was the rate of disease recurrence at 5 years after surgery
    • Patients had a mean recurrence score of 11.2
    • Eighty-five patients had grade 1 tumors, whereas 109 had grade 2 tumors and 6 had grade 3 tumors
    • The tumors were a mean of 10 mm
    • The median follow-up was 5.21 years
    • Both the overall survival rate and breast-cancer survival rate were 100% at 5 years:
      • The researchers reported, with a 5-year freedom-from-recurrence rate of 99% (95% CI, 96-100):
        • However, 2 patients died after the 5-year follow-up period had expired
    • There were two breast cancer related events during the follow-up period:
      • One event, which occurred at the 21-month mark:
        • Was an isolated axillary recurrence:
          • This was treated with axillary dissection and breast irradiation as well as local irradiation
      • The other was an ipsilateral breast event:
        • Which occurred at 49 months and was treated with another breast-conserving surgery
    • Another 6 patients experienced recurrence after the 5-year follow-up period, the researchers reported:
      • Five of these were ipsilateral breast events, and one was an ipsilateral breast event with regional occurrence
    • For the entire follow-up period:
      • The crude rate of ipsilateral breast events was:
        • 3.3% (n = 2 of 60) for patients who were 50 to 59 years old
        • 3.6% (n = 5 of 140) for those who were 60 to 69 years old
      • The crude overall relapse rates in these age groups were 5% (n = 3) and 3.6%, respectively
  • These findings indicate that younger postmenopausal patients with stage I breast cancer who skip radiotherapy after breast-conserving surgery:
    • Have a very low risk of disease recurrence within 5 years:
      • However, 5 years is an early time point for this population, and longer-term follow-up of this study and others will be essential to determine whether this option can be safely offered to women in this age group
  • Reference:
    • Jagsi, R. Five-year outcomes of the IDEA trial of endocrine therapy without radiotherapy after breast-conserving surgery for postmenopausal patients age 50-69 with genomically-selected favorable stage I breast cancer. Abstract GS02-08. SABCS 2023.
#Arrangoiz @Doctor #Surgeon #CancerSurgeon #SurgicalOncologist #BreastSurgeon #BreastCancer #MSMC #MountSiniaMedicalCenter #Miami #Mexico
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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