Tailored Radiotherapy Maintains Very Low Recurrence in Breast Cancer

New Approach Customizes Post-Surgery Treatment Based on Lymph Node Response

A groundbreaking ten-year study, unveiled at the 15th European Breast Cancer Conference (EBCC15) in Barcelona, indicates that tailored radiotherapy, administered to patients following chemotherapy and surgery, maintains a very low rate of breast cancer recurrence. This innovative treatment approach was meticulously customized based on whether cancer cells were still detectable in patients' lymph nodes after their initial therapies.

"Tailored radiotherapy, administered to patients following chemotherapy and surgery, maintains a very low rate of breast cancer recurrence."

Significantly, this method allows for reduced or even no radiotherapy in patients with no remaining cancer signs in their lymph nodes, potentially decreasing debilitating side effects.

Context of the Research

The research was presented by Dr. Fleur Mauritz, a radiation oncologist in training at Maastro, Maastricht Radiation Oncology Institute, The Netherlands. Dr. Mauritz highlighted the common treatment pathway for many breast cancer patients, where chemotherapy serves as the initial step to shrink tumors and eliminate spreading cancer cells before surgical intervention.

It is well-established that radiotherapy is crucial for reducing recurrence risk, particularly after the surgical removal of a tumor and when signs of cancer are present in lymph nodes. The core objective of this study was to investigate whether radiotherapy could be judiciously scaled back for patients whose cancer demonstrated a favorable response to pre-surgical chemotherapy.

The study investigated whether radiotherapy could be scaled back for patients whose cancer showed a favorable response to pre-surgical chemotherapy.

Study Design and Participants

The extensive study enrolled 848 patients who received treatment across 17 cancer centers throughout The Netherlands. Participants were recruited between 2011 and 2015. Each individual involved in the study had a relatively small breast tumor, under five centimeters, with initial evidence of cancer spread to one, two, or three lymph nodes.

Tailored Treatment Protocols Based on Risk

Following the completion of both chemotherapy and surgery, patients were carefully categorized into three distinct risk groups, dictating their subsequent radiotherapy regimen:

• Low Risk: Patients in this group showed no remaining signs of cancer in their lymph nodes after initial treatments.

  • They received radiotherapy to the breast if they underwent a lumpectomy.
  • No radiotherapy was administered if they had a mastectomy.

• Intermediate Risk: This group comprised patients who still presented with cancer signs in one to three lymph nodes.

  • They received radiotherapy exclusively to the breast area. Crucially, the nearby lymph nodes were not irradiated in these cases.

• High Risk: Patients fell into this category if they had cancer signs in four or more lymph nodes.

  • Their treatment involved radiotherapy to both the breast area and the surrounding lymph nodes.