Breast-conserving Surgery Without Radiation Therapy for Invasive Cancer

Clin Breast Cancer. 2021 Apr;21(2):112-119. doi: 10.1016/j.clbc.2021.01.001. Epub 2021 Jan 6.


Radiotherapy (RT) after breast-conserving surgery (BCS) halves the risk of local recurrence, and it is considered the standard of care for the vast majority of patients with early invasive breast cancer. However, the majority of patients treated with BCS will not recur locally, even in the absence of RT. Over the past several decades, the improved and widespread use of systemic therapy has significantly decreased the rate of local recurrence. This has stimulated interest in identifying favorable patient subsets not requiring RT. Randomized controlled trials have shown in women aged ≥ 70 years with stage I estrogen receptor-positive (ER+) tumors, RT can be safely omitted. To better identify patients with favorable prognosis, ongoing trials have incorporated biological markers and genomic assays. Despite great research efforts to de-escalate locoregional treatment, real-world data indicate that omission of RT in low-risk patients is inconsistent. Better decision-making is warranted to reduce overtreatment and financial toxicity.

Keywords: Local recurrence; Ongoing trials; Overtreatment avoidance; Patient selection; Radiotherapy omission.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Breast Neoplasms / pathology
  • Breast Neoplasms / radiotherapy*
  • Disease-Free Survival
  • Female
  • Humans
  • Mastectomy, Segmental / statistics & numerical data*
  • Neoplasm Recurrence, Local / prevention & control*
  • Neoplasm Staging
  • Radiation Oncology
  • Radiotherapy, Adjuvant / statistics & numerical data*