Premium
When not to give radiation therapy after breast conservation surgery for breast cancer
Author(s) -
De Csepel John,
Tartter Paul I.,
Gajdos Csaba
Publication year - 2000
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/1096-9098(200008)74:4<273::aid-jso6>3.0.co;2-v
Subject(s) - medicine , radiation therapy , breast cancer , surgery , stage (stratigraphy) , disease , cancer , paleontology , biology
Background and Objectives A significant proportion of breast cancer patients treated with breast conservation surgery do not receive adjuvant radiation therapy because of advanced age, severe intercurrent disease, or their own preference. We studied patients for whom adjuvant radiation was not performed, to determine whether the rate of local recurrence was acceptable in particular clinical circumstances. Methods Patients who had undergone breast conservation surgery for breast cancer were identified. The charts of patients who did not receive adjuvant radiation therapy were reviewed to identify the reason for omitting radiation. Local and distant recurrence rates were examined in relation to radiation and reason for omitting radiation. Results Forty‐three (9%, two bilateral) of the 487 patients did not receive radiation; 9 because of advanced age, 8 refused, 7 had severe intercurrent diseases, 6 developed stage IV disease while getting chemotherapy for stage III disease, 5 patients (1 bilateral) had two reasons for omission (3 cases: age + intercurrent disease; 2 cases: age + stage IV disease; and 1 case: age + small focus of ductal carcinoma in situ) and the remainder for miscellaneous reasons. None of the 13 patients with intercurrent disease or progression to stage IV disease developed local recurrence in their life time; 5 (63%) of 8 patients who refused radiation recurred in the breast; 2 (22%) 9 of the elderly patients developed local recurrences and none of the 6 cases with more than one reason for omission developed local recurrences. Conclusions Omission of radiation therapy after breast conservation is appropriate for patients with intercurrent diseases, for those who develop metastases while receiving preoperative chemotherapy and for selected elderly patients. Patients who refuse recommended adjuvant radiation therapy have unacceptably high rates of local recurrence. Omission of radiation for advanced age alone is associated with local recurrence rates comparable to those for younger patients. J. Surg. Oncol. 2000;74:273–277. © 2000 Wiley‐Liss, Inc.