Breast-conserving surgery with or without postoperative radiotherapy for early-stage breast cancer: 30-year update

As reported in The Lancet Oncology by Williams et al. A long-term follow-up of the phase III Scottish Breast Conservation Trial found that in patients undergoing breast-conserving surgery for breast cancer, postoperative radiotherapy was associated with a significantly lower risk of ipsilateral recurrence compared with no radiotherapy, although the risk difference was no longer significant after 10 years of follow-up.

Study details

The Scottish multicenter study included 585 eligible patients aged

Our findings suggest that patients whose biology predicts late recurrence a decade or more after breast-conserving surgery for early breast cancer are unlikely to benefit much from adjuvant radiotherapy.

— Williams et al

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Key findings

The median follow-up time was 17.5 years (interquartile range = 8.4–27.9 years).

Overall, ipsilateral recurrence was observed in 46 (16%) of 291 patients in the radiotherapy group versus 107 (36%) of 294 patients in the non-radiotherapy group (hazard ratio (HR) = 0.39, 95% confidence interval (CI) = 0.28–0.55, P (P = .95).

The median overall survival was 18.7 years (95% CI = 16.5-21.5 years) in the group without radiotherapy versus 19.2 years (95% CI = 16.9-21.3 years) in the radiotherapy group (HR = 1.08, 95% CI = 0.89-1.30, P = .43). Overall survival at 30 years was 27.5% (95% CI = 22.0%–32.9%) in the no radiotherapy group versus 23.7% (95% CI = 18.3%–29.0%) in the radiotherapy group. Among the 221 patients who died in the no radiotherapy group and the 222 patients who died in the radiotherapy group, 46% versus 37% died of breast cancer (P = .054) and 11% versus 20% died from other types of cancer (P = .012) or

The researchers concluded: “Our results suggest that patients whose biology predicts late recurrence a decade or more after breast-conserving surgery for early breast cancer may benefit little from adjuvant radiotherapy.”

Linda J. Williams, PhDfrom the Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, is the corresponding author for The Lancet Oncology Article.

Announcement: The study was funded by the Breast Cancer Institute (part of the Edinburgh and Lothian Health Foundation) and PFS Genomics (now part of Exact Sciences). Full details of the study authors can be found at thelancet.com.