A new study sheds light on a critical treatment decision facing older women diagnosed with early-stage, hormone receptor-positive breast cancer: whether to pursue radiation therapy or endocrine therapy following lumpectomy.
Published in Annals of Surgical Oncology, the research analyzed data from more than 91,000 women aged 65 and older with ER+/HER2− stage I breast cancer who underwent breast-conserving surgery. Jennifer Plichta, MD, surgical oncologist with the Duke Cancer Institute breast oncology program, helped lead this research.
“The problems with endocrine therapy are that treatment lasts up to 10 years and it can produce menopause-like symptoms – hot flashes, aches and pains,” Plichta said. “Because of that, women may not stay on it. And there are lots of benefits to radiation therapy for patients – it’s a shorter-term treatment, and patients don’t typically experience any additional menopause-like problems. So, we wondered, could we use radiation therapy and get at least similar benefits?”
Using the National Cancer Database, the study compared overall survival outcomes among patients who received only radiation therapy, only endocrine therapy, both therapies, or no adjuvant therapy. The team found that patients who only received radiation therapy had a slightly better five-year overall survival compared to patients who only received endocrine therapy, even after adjusting for age, comorbidities, and socioeconomic factors.
Based on these findings, Plichta and her team believe radiation-only therapy may be a more viable alternative to endocrine-only therapy for some older patients, particularly those with favorable tumor biology and concerns about long-term medication adherence.
“While it may still be bold to say radiation-only and endocrine-only therapy is better, it shows that this research is worth further exploration,” Plichta said.
Dr. Plichta and her team also drew on findings from the prospective, randomized EUROPA trial, which similarly compares these treatment modalities and has reported better quality of life and fewer side effects for patients with only radiation therapy, though survival outcomes from that trial are still pending.
Plichta said these early findings also point to the importance of shared decision-making between providers and patients. The more providers can understand treatment options, the better they can communicate with patients to help them make informed choices.
“Medicine is all about personalization,” Plichta said. “Our job is to help people decide what’s best for them, and we should be helping them achieve their health goals.”
