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Treatment FAQ Articles Part 3
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[article accessed from the web site August 17, 2010]

What says about this article…Radiation Benefits Women with Small Cancers After

After lumpectomy alone with clear margins, chances are that you are cancer-free. But your doctor will talk
to you about treatment you can have just in case some cancer cells were left behind.
In this situation, getting the best breast cancer treatment can feel like a balancing act: You want to do as
much as you can to get the cancer out and lower the risk of it coming back. But you'd like to avoid
uncomfortable side effects that might lower your quality of life.

In this study, the researchers wanted to see if there was a group of women who could get just hormonal
therapy after lumpectomy and skip radiation therapy. So they looked at a group of post-menopausal
women whose cancers are the type associated with the most favorable outcomes:

smaller than three centimeters, and
node negative.
If you're in this group, you have a very low risk of the cancer coming back.

As these results show, even women with a very low risk of recurrence can benefit from radiation after
surgery. This means that so far, no group of women has been found that would NOT benefit from whole
breast radiation.

Remember that no single treatment plan is right for everyone. If you want to do everything possible today
to lower the risk of ever seeing the cancer again, then radiation after lumpectomy may be a very important
step for you. If you have a small cancer that has been removed with wide and clear margins of resection
and you're more concerned about how radiation will affect you, you may want to talk to your doctor about
skipping radiation and just taking hormonal therapy. Your risk of the cancer coming back in the same area
is likely to be higher, but how long you live will probably not be affected.

Instead of having whole breast radiation, you can also talk to your doctor about the potential role of partial
breast radiation. Studies are now under way to test the effectiveness of radiation delivered just to the area
around the cancer. This is called partial breast radiation. Promising results after four years of using this
approach have led to a clinical trial that is now comparing partial breast radiation to whole breast radiation.
The trial is called the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-39 study. Talk to
your doctor—you may be able to enroll in the NSABP B-39 study.

Juggling risks that may affect your life can be very uncomfortable. You need to talk to your doctors and
family, and consider all your options, to decide on the plan that's right for YOU.

The February 2006 Research News section was made possible by an unrestricted educational grant from
Genentech BioOncology.

Research News on Radiation Therapy
ASCO: Radiation Short Course Now Breast CA Alternative
ASCO: Value of RT After Lumpectomy Questioned
Post-Mastectomy Radiation May Be Underused
SSO: Post-Mastectomy Radiation May Be Overused
Shorter Radiation Course Matches Standard for Breast Cancer
More Research News on Radiation Therapy (25 Articles)   

Reviewed study: "Radiation Benefits Women with Small Cancers After Lumpectomy" by M. F. X. Gnant and
others, San Antonio Breast Cancer Symposium, December 8, 2005, Abstract 8

Is this for me? If you have small, early-stage invasive breast cancer and are wondering if you can skip
radiation after surgery, you might want to read this article.

Background and importance of the study: Breast-conserving surgery lumpectomy followed by radiation—
has become a standard treatment for women with breast cancers that:

are small to medium in size (usually four centimeters—about two inches—or less in diameter),
are limited to one place in the breast, and
can be removed with clean margins.

Radiation to the whole breast after lumpectomy has been recommended for all women who choose breast
conservation (instead of breast removal, or mastectomy), regardless of the women's age. This "standard
of care" recommendation is based on many large studies that compared lumpectomy plus whole breast
radiation to lumpectomy alone. These studies showed that radiation therapy after lumpectomy significantly
reduced the risk of the breast cancer coming back in the same breast.

The studies also found that women with node-negative disease lived equally long lives after lumpectomy
alone or lumpectomy plus radiation. Women with node-positive disease had an increase in survival. The
main benefit from radiation is to lower the risk that cancer might return in the breast, requiring more
surgery and possibly other treatments.

Other treatments may be given after surgery. Hormonal therapy is a medicine given after surgery for
hormone-receptor-positive breast cancer. Hormonal therapy:

lowers the risk of the cancer coming back,
improves survival after surgery, and
lowers the risk of developing breast cancer in the other breast.
With all these different types of post-surgery treatments, it would be helpful to know who needs radiation
treatment and who might do fine with hormonal therapy alone. Several studies have looked at whether
hormonal therapy offers enough protection against recurrence after lumpectomy for women with small
cancers—eliminating the need for radiation. This could spare some women the inconvenience, side
effects, and cost of radiation.

The study reviewed here continues to look at this important question. Keep in mind that ALL of the women
in this study had relatively small cancers and no lymph node involvement. They then received hormonal
therapy and about half received radiation too. So this study does not address the role of radiation alone
without hormonal therapy.

Study design: Austrian researchers used the results of two studies conducted by the Austrian Breast
Cancer Study Group (ABCSG) to identify groups of women who had an extremely low risk of recurrence
(the breast cancer coming back).

All the women were post-menopausal and had breast cancer that was:

smaller than three centimeters, and
node negative.
All the women had lumpectomy followed by different types of hormonal therapy:

In ABCSG-6, 698 women took tamoxifen with or without aminoglutehimide (an old-fashioned kind of
aromatase inhibitor).
In ABCSG-8, 875 women took either five years of tamoxifen or two years of tamoxifen followed by three
years of Arimidex (chemical name: anastrozole).
About half of the women in each study were randomly assigned to receive radiation after lumpectomy and
before hormonal therapy. The other half had lumpectomy followed by hormonal therapy—without radiation.

Results: After about 10 years of follow-up in the ABCSG-6 trial, the cancer came back in

3.3% of the women who had radiation, compared to
5.2% of the women who didn't receive radiation.
However, this difference was not significant, meaning it could be due to chance rather than due to the

After about four years of follow-up in the ABCSG-8 trial, the cancer came back in

0.24% of the women who had radiation, compared to
3.2% of the women who didn't have radiation.
This difference was statistically significant, meaning that it was likely due to the radiation and not just to

There was no difference in overall survival in either trial between women
who had radiation treatment and women who did not.

Conclusions: The researchers concluded that radiation therapy to the whole breast can help reduce the
risk of recurrence in women with small hormone- receptor-positive breast cancers, even if they receive
hormonal therapy after lumpectomy.


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