By the numbers.

Women with high 21-gene recurrence scores do well with hypofractionation, but how do they do when radiation is omitted? This NCDB analysis investigated the benefit of radiation among older women (≥70) with T1 N0, hormone receptor positive breast cancer who were treated with breast conservation surgery and endocrine therapy. Nearly 12,000 patients had recurrence scores reported with 28.3% having a low score (1-10), 61.4% intermediate (11-25), and 10.3% high (>25). Among those with high and intermediate scores, receipt of radiation was associated with improved overall survival on multivariable analysis. However, that didn’t hold true for low recurrence scores. NCDB studies have their own inherent biases, but this study suggests that older women with hormone receptor positive breast cancer and an intermediate to high recurrence score benefit from adjuvant radiation in addition to endocrine therapy. | Chevli, Radiother Oncol 2022