More Radiation May Minimize Recurrence

An important new study published in the New England Journal of Medicine has concluded that an additional boost of localized radiation for younger women who have undergone lumpectomy-after the standard post-surgical dose of radiation-may minimize the risk of local recurrence.

Breast-conserving surgery (usually lumpectomy) followed by local radiotherapy is a standard treatment for early breast cancer. However, a team of European oncologists, led by Dr. Harry Bartelink of the Netherlands Cancer Institute in Amsterdam, has determined that an additional "booster dose" aimed directly at the tumor site can dramatically reduce the risk of local recurrence, especially for women younger than 50 years of age.

Bartelink's team followed 5,318 women who had a lumpectomy and axillary lymph node dissection followed by a standard dose of 50-Gy radiation to the whole breast. Approximately half of the women (2,661) were then randomized to receive an additional dose of localized 16-Gy radiation directly at the tumor site.

After a median follow-up period of 5.1 years, 182 patients in the standard treatment group had a local recurrence of their cancer (6.8 percent), compared with 109 in the "booster radiation" group (4.1 percent).

Younger women appeared to benefit the most from the additional radiation treatment. For women under age 40 there was a 19.5 percent local recurrence rate with standard therapy, compared to a 10.2 percent rate for those who had the additional "booster" radiotherapy. Similar benefits were discernable for women under age 50.

"In patients with early breast cancer who undergo breast-conserving surgery and receive 50-Gy of radiation to the whole breast," they wrote, "an additional dose of 16-Gy of radiation to the tumor bed reduces the risk of local recurrence, especially in patients younger than 50 years of age."

They suggested that their findings should be taken into consideration by younger women who have undergone breast-conserving surgery and standard radiation therapy for early-stage breast cancer. However, they cautioned that continued research, with a longer follow-up period, was needed to determine how the booster dose of radiation affects long-term survival.

SOURCE:
New England Journal of Medicine, November 8, 2001; 345:1378-1387

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