Older Breast Cancer Patients Want Radioactive Implants,
No Radiation for E+ Tumors
Women with estrogen negative tumors 91% more likely
to die if they did not receive radiation therapy after a lumpectomy,
finds second study
June 3, 2011 – More older women – 70 and older –
with stage I breast cancer are opting for radioactive implants, and
those with estrogen positive tumors are opting out of radiation therapy,
according to studies being presented Saturday at the American Society of
Clinical Oncology meeting in Chicago. These are notable changes in past
patterns of radiation usage among senior citizens.
This abstract by Jefferson University Hospital
researchers received an ASCO Merit Award.
In another abstract, the researchers report that
women with estrogen negative tumors were 91 percent more likely to die
from breast cancer if they did not receive radiation therapy after a
Given the relatively recent developments in
radiation therapy (i.e., an increased use of brachytherapy and external
beams) and data supporting the idea that radiation isn't necessary for
women with estrogen positive tumors, researchers wanted to see how
actual practice patterns were impacted.
Researchers found that there was a modest increase
in the percentage of women with estrogen receptor positive cancers who
did not get radiation therapy starting around 2004, and increasing use
of radioactive implants, such the MammoSite, Contura, Savi or similar
devices, since 2002.
There was also a corresponding drop in women who
received external beam radiation, according to Xinglei Shen, M.D., a
resident in the Department of Radiation Oncology at Thomas Jefferson
University Hospital. "Among women with estrogen receptor negative
cancers, there was not the same increase in frequency of women who did
not get radiation, but there was an increased use of radioactive
implants," he said.
The consequence of those findings was determining
what impact omitting radiation has on survival. While there is data that
the omission of radiation therapy in women with estrogen receptor
positive tumors who receive endocrine therapy, such as Tamoxifen, is not
associated with a survival difference, limited data exists for estrogen
receptor negative tumors in older women who undergo breast conservation.
"From the randomized trial data, we know that women
with estrogen receptor positive stage I breast cancer have no detriment
to survival by avoiding radiation, as long as they took Tamoxifen," Dr.
Shen said. "However, it is unknown if this would be the case in women
with estrogen receptor negative cancer."
Dr. Shen worked with Jefferson Medical College
student Andrzej Wojcieszynski to examine survival in these women, and
found that they were 91 percent more likely to die from breast cancer if
they did not receive radiation therapy after a lumpectomy. (Abstract
"We have to be cautious when interpreting survival
data from the SEER because of potential confounding variables, such as
the health of the patients and use of chemotherapy," Dr. Shen said.
"However, these data do raise hypotheses for future study."
"Our conclusion is that adjuvant radiation therapy
after lumpectomy reduces breast cancer mortality in women over 70 with
stage I, estrogen receptor negative breast cancers, and that radiation
is currently underutilized in these women," said Wojcieszynski.
The Kimmel Cancer Center at Jefferson is one of a
select group of National Cancer Institute-designated Clinical Cancer
Centers in the nation. It was founded in 1991 with approximately 30
investigators in basic sciences. Today, the KCC has approximately 150
members that include physicians and scientists dedicated to discovery
and development of novel approaches for cancer treatment.
Thomas Jefferson University, the largest
freestanding academic medical center in Philadelphia, is composed of
Jefferson Medical College, Jefferson College of Graduate Studies,
Jefferson School of Population Health, Jefferson School of Health
Professions, Jefferson School of Pharmacy, and Jefferson School of
Nursing. Jefferson is regarded nationally as one of the best
universities offering a range of comprehensive programs for the
education of health professions. Thomas Jefferson University partners
with Thomas Jefferson University Hospital, its education and clinical
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