Albert JM, Liu DD, Shen Y et al.
University of Texas MD Anderson Cancer Center, Houston, TX, USA.
J Clin Oncol 2012;30:2837–43.
Murid Chaudary’s review: Although almost half of all breast cancers are diagnosed in women aged ≥65 years, the importance of radiation therapy after breast-conserving surgery (BCS) remains controversial in this population. In general, radiotherapy is recommended in older women to prevent local recurrence and preserve the breast. However, multiple clinical trials have shown that the risk of locoregional recurrence (LRR) decreases with age, and recent trials have suggested that radiotherapy may have minimal benefit in older patients who have a lower baseline recurrence risk. The Cancer and Leukemia Group B 9343 trial showed that within a highly selected group of patients aged ≥70 years, despite radiotherapy reducing the 10-year risk of LRR from 9% to 2%, radiotherapy did not improve the mastectomy-free survival (MFS) or overall survival rate (N Engl J Med 2004;351:963–70). These data suggested that the small local control benefit of radiotherapy may not translate into an improved likelihood of breast preservation or survival. In response, the US National Comprehensive Cancer Network modified their guidelines to state that radiation may be omitted in women aged ≥70 years with estrogen receptor (ER)-positive, stage I breast cancer receiving endocrine therapy.