Study Says Lumpectomy Followed by Breast Radiotherapy Increases Survival

Recurrence rate decreased by 50 percent compared to women who only have the breast-conserving surgery, research finds

The findings of a new study suggest that women with breast cancer who go through radiotherapy following a lumpectomy have remarkably lower recurrence rates and as a result, higher chances of survival compared to those who don’t undergo radiotherapy.

In addition, the researchers did not find any long-term adverse effects from radiotherapy following the breast-conserving surgery, as there was also a significant reduction in the number of deaths due to any cause.

According to Dr. Jay Harris, chairman of radiation oncology at Dana-Farber Cancer Institute and Brigham & Women’s Hospital in Boston, “For the first time, this showed this important linkage between using radiation to avoid local recurrence and improving long-term survival.” He said that up until the year 2005, the widespread attitude in the United States was that “radiation did not have an impact on improving long-term survival and was strictly to reduce local recurrence.”

Dr. Shelly Hayes, a radiation oncologist connected with Fox Chase Cancer Center in Philadelphia, said that the administration of radiotherapy following breast-conserving treatment is already commonly done.

The findings of the new study reiterate the results of a milestone paper in 2005 that included fewer women and a shorter follow-up period. Experts said that these findings should help wipe away any remaining doubts from the minds of skeptics.

According to Harris, it will be “very helpful to see updated results with lots more patients, lots more follow-up and this is very substantial improvement in long-term outcome.”

For the study, the researchers looked at data on nearly 11,000 women in 17 randomized trials that made a comparative analysis of radiotherapy after lumpectomy versus lumpectomy alone.

The authors made use of the extraordinary approach of covering both published and unpublished trials, enabling them to come up with data that’s “very reliable,” Harris said.

The researchers said that in general, subjecting the affected breast to radiotherapy cut down recurrence rates by 50 percent and reduced the number of deaths by one-sixth.

After a follow-up period of 10 years, 35 percent of women who did not go through radiotherapy had experienced a recurrence compared with just about half as many (19 percent) of women who had radiotherapy.

And 15 years after being diagnosed with breast cancer, 25 percent of women who had radiotherapy had survived, compared with 21 percent in the non-radiation group. The researchers found that during that time, the total risk reduction in all-cause death rate was 3 percent.

The figures differed in relation to some factors such as age, tumor grade, estrogen-receptor status, whether the patient had been treated with tamoxifen — a drug that suppresses estrogen – as well as the extent of the surgery.

“The magnitude of the benefit got smaller with more favorable factors, but there were benefits in every subgroup,” Hayes said, which, according to her, turned into advantage with regards to recurrence risk, which turned into survival in general.

Hayes said that “Across the board, no matter what those features were,” radiation provided beneficial effects to women.

Sarah Darby, professor of medical statistics at the University of Oxford in England, and a co-author of the study, said that for some time, doctors have speculated whether radiotherapy was really essential for all women.

She said that the findings of this study will allow both doctors and patients to have a deeper understanding “of the benefit that is likely to be gained from radiotherapy on a patient-by-patient basis.”

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