Post-mastectomy radiation may not be helpful for early-stage breast cancer

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Patients with early-stage breast cancer may not need radiation following mastectomy, according to a study presented at the 2010 Society of Surgical Oncology Annual Cancer Symposium.

“There is currently no question that radiotherapy after mastectomy is effective at decreasing the chances of LRR [long-range recurrence] and is indicated in breast cancer patients with lymph node spread in greater than four nodes and where the risk of LRR is higher than 10% to 15%,” explained Henry Kuerer, MD, PhD, professor and training program director in M.D. Anderson's Department of Surgical Oncology. “However, the need for post-mastectomy radiation in early stage breast cancer patients has been a topic of great debate within the cancer community.”

In a study of 1,022 stage I and II breast cancer patients who received a mastectomy, researchers found that there was no statistical difference in the 10-year risk of LRR in women without lymph node spread compared to those with spread to one node.  Stage I and II patients without spread to auxiliary lymph nodes or with one to three lymph nodes with metastasis who received surgery and adjuvant chemotherapy without radiation had a low overall risk of locoregional recurrences (LRR).

“for the overwhelming majority of early-stage breast cancer patients treated with modern surgery and systemic therapies, LRR rates may be too low to justify routine use of post-mastectomy radiation,” said Dr. Kuerer. “This research will provoke much discussion among those caring for women with early-stage breast disease. Replicating these findings should be a priority to ensure that patients only receive therapy that is medically necessary.”

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