For decades, radiation therapy has been a standard post-mastectomy treatment to prevent recurrence of breast cancer. But a new, large-scale international study published this week in the New England Journal of Medicine is challenging that practice, suggesting many patients may safely forgo radiation without impacting survival rates. The decade-long SUPREMO trial, involving over 1,600 patients across 17 countries, found no notable difference in overall survival or distant recurrence between those who received radiation and those who did not, offering a potential path toward less invasive treatment for certain breast cancer patients.
Researchers have revealed that some patients with early-stage breast cancer may be able to safely avoid radiation therapy after a mastectomy without compromising their chances of survival. This finding has the potential to significantly reduce the burden of treatment for many women facing a breast cancer diagnosis.
For decades, radiation therapy following mastectomy has been a standard practice for women with early-stage breast cancer, aimed at eliminating any remaining cancer cells in the chest wall and lowering the risk of recurrence. However, a new study published November 5 in The New England Journal of Medicine challenges this long-held practice.
The research suggests that “radiation therapy can be safely omitted as treatment for many patients with breast cancer who have undergone mastectomy and are taking cancer medications.” This conclusion stems from a large-scale clinical trial designed to re-evaluate the necessity of radiation in certain cases.
1,607 Patients Followed for a Decade
The clinical trial, known as SUPREMO and led by the University of Edinburgh, focused on women with an intermediate risk of recurrence. A total of 1,607 patients from 17 countries who had undergone mastectomy, axillary surgery, and were receiving modern anti-cancer treatment were enrolled. Participants were randomly assigned to receive either radiation therapy (808 patients) or not (799 patients).
No Difference in Overall Survival or Recurrence Risk
After ten years of follow-up, the results showed no statistically significant difference in overall survival between the two groups. The survival rate was 81.4% for those who received radiation therapy and 81.9% for those who did not. Similarly, there was no impact on the risk of cancer recurrence or spread. “Radiation therapy had no impact on survival without recurrence or on the spread of breast cancer in the body,” the study found.
A slight difference was observed in local recurrences, with 9 cases of recurrence on the chest wall in the radiation therapy group compared to 20 in the group that did not receive radiation. Side effects were reported as mild, and “no additional cardiac-related deaths were reported.”
Researchers attribute this finding to significant advancements in anti-cancer therapies. Improvements in medication have substantially reduced the risk of recurrence, making the benefit of radiation therapy “smaller than previously thought.”
A Major Advance, But Not for All Patients
Experts caution that these findings do not apply to all breast cancer patients. The study specifically focused on those with an intermediate risk of recurrence. “Patients with a higher risk of recurrence may still benefit from radiation therapy to the chest wall,” the research team emphasized.
However, the results are expected to influence clinical practice. “They should help guide treatment discussions,” researchers stated. This means that many patients currently recommended for radiation therapy may no longer require it, potentially offering a less intensive treatment course without compromising their chances of recovery. The findings represent a hopeful development for women facing a challenging and often arduous treatment journey.
