No radiation for some breast ca patients.(News)

Adjuvant radiation may not be necessary for some women over age 70 who undergo lumpectomy for early breast cancer, but it still should be used in younger women, results of two large, randomized studies suggest.

In recent years, adjuvant medical therapy after lumpectomy, including tamoxifen, has become widespread, leading investigators in these two trials to study whether radiotherapy is still needed in women receiving tamoxifen after breast-conserving surgery.

In both of the multicenter studies, women with early breast cancer treated by lumpectomy were randomized to adjuvant therapy with tamoxifen plus radiation or tamoxifen alone. The American study included patients aged 70 years or older with estrogen receptor-positive cancers; the Canadian study included patients aged 50 years and older, 79% of whom had estrogen receptor-positive cancers.

With a median follow-up of 5 years, the American study of older women found no significant differences between 319 women who received tamoxifen plus radiotherapy and 317 women who received tamoxifen alone in the rate of mastectomy for local recurrence, risk for distant metastases, or overall survival, reported Dr. Kevin S. Hughes of Massachusetts General Hospital, Boston, and his associates (N. Engl. J. Med. 351:971-77, 2004).

Although the tamoxifen-alone group showed a significantly higher rate of local or regional recurrence, compared with the tamoxifen-plus-radiation group (4% vs. 1%), "patients and their physicians should weigh the slightly increased risk of local recurrence against the cost, inconvenience, and adverse effects of irradiation," Dr. Hughes and his associates said.

During the first 2 years of follow-up, physician ratings of fibrosis, retraction, overall cosmesis, breast pain, edema, and skin-color changes were significantly worse for the tamoxifen-plus-radiation group than in the tamoxifen-alone ...