Sin of omission.

Randomized trials have demonstrated the relative safety of omitting adjuvant breast radiation in older women with low risk breast cancer. The problem is, that approach assumes a woman will comply with adjuvant endocrine therapy (ET) for 5+ years. We’ve seen a number of times already in real-world studies that compliance for adjuvant ET is poor. This Canadian population-based study compared treatment outcomes for >1100 women over 70 who received breast conservation surgery followed by RT+ET (42.5%), ET alone (14%), RT alone (32.5%), or no further treatment (11%). Among those taking ET, only about half completed 5 years. Overall, the biggest predictors of survival were age, comorbidities, tumor characteristics, and receipt of adjuvant therapy. But when it came to the type of adjuvant therapy, there was no difference in recurrence-free survival outcomes. TBL: Given the brief course (5-15 fractions), good compliance, and efficacy comparable to ET alone, perhaps it’s time we considered an RT alone option for some older women with low-risk breast cancer. | Joseph, Radiother Oncol 2020