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Omission of postoperative radiotherapy after breast-conserving surgery in low-risk breast cancer

Palmér, Sofia ; Valachis, Antonis ; Lindman, Henrik ; Smith, Daniel Robert ; Wickberg, Åsa ; Killander, Fredrika LU ; Bjöhle, Judith ; Einbeigi, Zakaria ; Nilsson, Greger and Ahlgren, Johan , et al. (2025) In Journal of the National Cancer Institute 117(6). p.1125-1133
Abstract

Background This prospective cohort study aimed to assess whether postoperative radiotherapy could safely be omitted in women aged 65 years and older with low-risk, estrogen receptor-positive T1N0 breast cancer treated with breast-conserving surgery and adjuvant endocrine therapy. Methods Eligible patients were women aged 65 years and older with unifocal, nonlobular, grade 1 or 2, estrogen receptor-positive, pT1N0 breast cancer treated with breast-conserving surgery and endocrine therapy for 5 years. Patients were followed up with mammography at least annually for 10 years. The primary endpoint was local recurrence. Secondary endpoints were contralateral breast cancer, recurrence-free survival, and overall survival. Results The final... (More)

Background This prospective cohort study aimed to assess whether postoperative radiotherapy could safely be omitted in women aged 65 years and older with low-risk, estrogen receptor-positive T1N0 breast cancer treated with breast-conserving surgery and adjuvant endocrine therapy. Methods Eligible patients were women aged 65 years and older with unifocal, nonlobular, grade 1 or 2, estrogen receptor-positive, pT1N0 breast cancer treated with breast-conserving surgery and endocrine therapy for 5 years. Patients were followed up with mammography at least annually for 10 years. The primary endpoint was local recurrence. Secondary endpoints were contralateral breast cancer, recurrence-free survival, and overall survival. Results The final study cohort included 601 patients with a median age of 71 years (range = 65-90 years) and a median tumor size of 11 mm (range = 3-20 mm). Median follow-up time was 119 months (interquartile range = 103-121 months). The cumulative incidence of local recurrence was 1.5% (95% confidence interval [CI] = 0.8% to 2.8%) and 5.5% (95% CI = 3.8% to 7.6%) at 5 and 10 years, respectively. The cumulative incidence of contralateral breast cancer was 1.7% (95% CI = 0.9% to 3.0%) at 5 years and 4.5% (95% CI = 3.0% to 6.6%) at 10 years. The overall survival rate at 10 years was 83.1% (95% CI = 80.8% to 85.4%). In total, 3 (0.5%) patients died because of breast cancer. Conclusion Our results support the possibility to omit radiotherapy after breast-conserving surgery in a well-defined subgroup of women aged 65 years and older with low-risk, estrogen receptor-positive, pT1N0 breast cancer receiving adjuvant endocrine therapy.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of the National Cancer Institute
volume
117
issue
6
pages
9 pages
publisher
Oxford University Press
external identifiers
  • pmid:39656805
  • scopus:105008251808
ISSN
0027-8874
DOI
10.1093/jnci/djae315
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2024 The Author(s).
id
25e5b03a-8af3-4c8f-9d81-d2405a7bb1ee
date added to LUP
2025-12-17 17:03:41
date last changed
2025-12-18 03:00:05
@article{25e5b03a-8af3-4c8f-9d81-d2405a7bb1ee,
  abstract     = {{<p>Background This prospective cohort study aimed to assess whether postoperative radiotherapy could safely be omitted in women aged 65 years and older with low-risk, estrogen receptor-positive T1N0 breast cancer treated with breast-conserving surgery and adjuvant endocrine therapy. Methods Eligible patients were women aged 65 years and older with unifocal, nonlobular, grade 1 or 2, estrogen receptor-positive, pT1N0 breast cancer treated with breast-conserving surgery and endocrine therapy for 5 years. Patients were followed up with mammography at least annually for 10 years. The primary endpoint was local recurrence. Secondary endpoints were contralateral breast cancer, recurrence-free survival, and overall survival. Results The final study cohort included 601 patients with a median age of 71 years (range = 65-90 years) and a median tumor size of 11 mm (range = 3-20 mm). Median follow-up time was 119 months (interquartile range = 103-121 months). The cumulative incidence of local recurrence was 1.5% (95% confidence interval [CI] = 0.8% to 2.8%) and 5.5% (95% CI = 3.8% to 7.6%) at 5 and 10 years, respectively. The cumulative incidence of contralateral breast cancer was 1.7% (95% CI = 0.9% to 3.0%) at 5 years and 4.5% (95% CI = 3.0% to 6.6%) at 10 years. The overall survival rate at 10 years was 83.1% (95% CI = 80.8% to 85.4%). In total, 3 (0.5%) patients died because of breast cancer. Conclusion Our results support the possibility to omit radiotherapy after breast-conserving surgery in a well-defined subgroup of women aged 65 years and older with low-risk, estrogen receptor-positive, pT1N0 breast cancer receiving adjuvant endocrine therapy.</p>}},
  author       = {{Palmér, Sofia and Valachis, Antonis and Lindman, Henrik and Smith, Daniel Robert and Wickberg, Åsa and Killander, Fredrika and Bjöhle, Judith and Einbeigi, Zakaria and Nilsson, Greger and Ahlgren, Johan and Villman, Kenneth}},
  issn         = {{0027-8874}},
  language     = {{eng}},
  month        = {{06}},
  number       = {{6}},
  pages        = {{1125--1133}},
  publisher    = {{Oxford University Press}},
  series       = {{Journal of the National Cancer Institute}},
  title        = {{Omission of postoperative radiotherapy after breast-conserving surgery in low-risk breast cancer}},
  url          = {{http://dx.doi.org/10.1093/jnci/djae315}},
  doi          = {{10.1093/jnci/djae315}},
  volume       = {{117}},
  year         = {{2025}},
}