Breast cancer, is radiotherapy after surgery also appropriate for women over 65? – time.news

2023-04-18 06:51:56

Of True Martinella

On the one hand, the aim is to save patients with breast cancer at low risk of recurrence “excess treatments” (and related toxicity), on the other hand, the danger of local relapses and distant metastases must be considered

The radiotherapy sessions are a cornerstone in the treatment of breast cancer for their undoubted usefulness in the reduce the risk of both local recurrences (post-surgery radiation helps to “clean up” the area affected by the tumor better) and of distant metastases. In the face of undoubted advantages for the patients, however, specialists always weigh the possible disadvantages in terms of side effects (mostly pain and the appearance of lymphedema, the annoying swelling in the arm). Especially in elderly women and with a non-aggressive neoplasm diagnosed in the initial stage, Do you really need radiation therapy? Not doing so reduces their prospects for survival? To answer these questions, a team of British researchers conducted a study, the results of which were published in the scientific journal New England Journal of Medicine
involving more than 1,300 women aged over 65 who were operated on for early stage breast cancer.

I study

The phase three trial enrolled 1,326 patients with hormone-responsive breast cancer and with negative lymph nodes in the early stages, less than three centimeters in size, and aged over 65 years. The participants were divided into two groups: 658 received, in addition to hormone therapy, standard radiotherapy after conservative surgery, while 688 did not receive radiotherapy. Researchers have them followed for an average of 10 years The trial results indicate that avoiding radiation does not affect patient survival or the risk of distant metastases increase the chances that the cancer will come back locally, or in the area where it had been removed, thus requiring a second operation. “Non-irradiation has a heavy impact on the risk of local relapse which increases by about ten times – he comments Cynthia Iotti, president of the National Association of Radiotherapy and Clinical Oncology (Airo) —. It’s not a secondary issue. First of all for the patients themselves, who often experience the reappearance of the disease and the need for another operation very badly. And then why relapse requires other therapies (also drugs, in addition to the scalpel), with relative induced toxicity and a worsening of the quality of life. With the additional risk of no longer being able to receive optimal therapies.

Weigh the pros and cons

Also for Italian specialists it is important to limit as much as possible the prescription of “excess” treatments, which involve costs for the health service and potential toxicity for women. Several scientific studies are in fact trying to understand when it is possible avoid radiation. «There are several underway, including an Italian multicentre (EUROPA) which is comparing the local control of the disease and the quality of life of patients over 70 who, after conservative surgery, undergo radiotherapy alone (in five sessions) versus radiotherapy alone hormone» continues Iotti, who is director of Radiotherapy at the AUSL IRCCS of Reggio Emilia. The conclusions of the British study, on the other hand, are not sufficient to eliminate radiotherapy in patients defined as “elderly” because it has several limitations: “First of all defining 65 as “advanced age” today is anachronistic because these are people who can easily have a life expectancy of more than 15 years,” he underlines Icro Meattini, specialist in oncological radiotherapy at the Careggi University Hospital in Florence —. Therefore, from the point of view of oncological treatments, they are not to be considered elderly. Then the study sample is too small to draw definitive conclusions in terms of survival.

Personalized choices

We must also consider, for the quality of life of women, that the toxicity of radiotherapy today can be very limited thanks to more modern, personalized and “targeted” techniques and dosages different from those used in the British trial, effective and with a tolerance profile definitely very good. «Finally, already today some “elderly” patients with this type of neoplasm do not receive radiotherapy for various reasons – concludes Meattini, associate professor of Radiotherapy at the University of Florence -. The radiation oncologist evaluates each woman’s set of variablesweighing the pros and cons case by case, to then propose to the woman the option she deems most advantageous».

April 18, 2023 (change April 18, 2023 | 06:51)

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