30-year follow-up data: Can early-stage breast cancer be treated without chemotherapy?

For early-stage breast cancer, breast-conserving surgery is usually treated with radiation therapy with chemotherapy or tamoxifen to reduce the risk of
recurrence.
But how long can this risk-reducing benefit from chemotherapy last? Ten years, thirty years?

Radiation therapy
for breast cancer.
Source: Mayo

Treatment of early-stage breast cancer

Treatment of early-stage breast cancer includes surgery and chemoradiotherapy
.
There are two options for surgery: mastectomy and breast-conserving surgery
.
Mastectomy is the removal of the entire breast and breast reconstruction
can be done after the procedure.
Breast-conserving surgery, as the name suggests, involves the removal of the cancer lesion and part of the healthy tissue at the edge, which is able to preserve the breast
.

Compared to mastectomy, breast-conserving surgery may have residual cancer cells, which are usually killed by radiation therapy to the breast after surgery
.

In addition to local treatments such as surgery and chemotherapy, patients are generally given systemic chemotherapy to further kill the remaining cancer cells and reduce the chance of
cancer recurrence.

Both radiation and chemotherapy have some side effects
.
Are all these treatments necessary? What can I not do?

The benefit of chemotherapy may be only ten years

Ian Kunkler, a professor of clinical oncology at the University of Edinburgh in the United Kingdom, published a study at the recent 13th European Breast Cancer Conference: radiotherapy after breast-conserving surgery combined with chemotherapy or tamoxifen treatment for early-stage breast cancer can reduce the risk of ipsilateral breast cancer recurrence in the next decade, but it has little effect on the risk after this and does not improve overall survival after 30 years
.

The researchers followed 585 patients aged 70 or younger for 30 years
.
The patient underwent breast-conserving surgery
after being diagnosed with early-stage breast cancer.
Then, depending on whether the breast cancer is driven by estrogen, the patient is treated with tamoxifen or chemotherapy
.
The patients were divided into two groups, one who received radiation after surgery and one who did not
.

Within ten years of completion of radiotherapy, the local recurrence rate of the ipsilateral breast in the radiotherapy group was reduced by more than 60%, a significant
difference compared with patients who did not receive radiotherapy.

However, after the first decade, the risk of recurrence was similar in both groups, and overall survival rates were similar
.
After 30 years of treatment, the survival rate of patients in the radiotherapy group was 24%, while the survival rate of patients who did not receive radiotherapy was actually higher, reaching 27.
5%.

Why did 30-year overall survival not improve in the radiotherapy group?

The benefit of radiation therapy in reducing local recurrence of breast cancer was only evident in the first decade after radiation therapy, after which local recurrence and survival rates were similar regardless of whether the patient had been treated with or without radiation therapy
.

Radiotherapy did not improve the risk of recurrence and overall survival in breast cancer patients after ten years, possibly because although radiation therapy may help prevent some breast cancer-related deaths, this is particularly evident in the first decade after treatment; But radiation therapy always has certain side effects on the body, and long after radiation therapy, it may lead to more other factor-related deaths, such as deaths due to cardiovascular disease
.

The findings challenge the idea that radiotherapy improves long-term survival by preventing cancer recurrence in the same breast
.
We expect more data to further confirm this finding in the future, and the cancer degree will continue to be tracked
for everyone.

Can early-stage breast cancer be treated without chemotherapy? Cancer is a reminder that every breast cancer patient is different, and the decision to give radiation therapy after surgery should be made by the patient and the physician after careful discussion, taking into account the individual characteristics of the patient and the risk of recurrence in the long term, as well as treatment-related toxicity
.

Cancer, accompany you through every step of the fight against cancer!

References:

"Randomised controlled trial of breast conserving therapy: 30-year analysis of the Scottish breast conservation trial", Friday 18 November, 'Questions for innovations in radiotherapy' clinical symposium, 10.
30-12.
00 hrs CET, room 111.

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