Breast De-escalation

[radiation]

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Selective Elimination of Breast Surgery for Invasive Breast Cancer

This nonrandomized trial examines 5-year efficacy outcomes evaluating radiotherapy alone without breast surgery in patients with breast cancer selected with image-guided vacuum assisted biopsy.

jamanetwork.com

Maybe all those breast de-escalation trials may eventually come in handy. First they get rid of axillary surgery, now they are coming for lumpectomy

 

[thesauce]

Selective Elimination of Breast Surgery for Invasive Breast Cancer

This nonrandomized trial examines 5-year efficacy outcomes evaluating radiotherapy alone without breast surgery in patients with breast cancer selected with image-guided vacuum assisted biopsy.

jamanetwork.com

Maybe all those breast de-escalation trials may eventually come in handy. First they get rid of axillary surgery, now they are coming for lumpectomy

No kidding.

It saw some definitive SBRT studies awhile back. I feel like if you can get rid of SLN in a low risk breast cancer, SBRT would be just as good a surgery.

Then salvage could be treated with whole breast or possibly surgery at that point.

 

[drowsy12]

I’m all for radiation over surgery in many disease sites. However I don’t know if sbrt to high doses in breast is actually better cosmesis than just a simple lumpectomy?

 

[thesauce]

I’m all for radiation over surgery in many disease sites. However I don’t know if sbrt to high doses in breast is actually better cosmesis than just a simple lumpectomy?

I would say better in terms of not only cosmesis, but also long term side effects (seen a fair bit of mastalgia with lumpectomy) and also better in terms of risk (avoiding anesthesia as well) and health system cost with OR time, facility fees, disposables and the occasional overnight stay.

 

[drowsy12]

What’s the dose? I’m open to it but 50/5 to skin/soft tissue doesn’t sound that great. It’s a harder sell than many other things imo (liver lung kidney etc)

This particular patient population especially.

 

[A_DeMichele]

WBRT is probably overkill for this concept. Maybe 30 Gy / 5fx PBI instead?

 

[Mandelin Rain]

Lumpectomy is so effective and well tolerated feels like it’d be (almost) crazy to try to replace it in low risk breast cancer.

I can see the appeal in post chemo CR setting where you’re treating potential residual microscopic disease, i.e. the role of radiation in breast cancer for like the last 50 years.

 

[pikachu]

Lumpectomy is so effective and well tolerated feels like it’d be (almost) crazy to try to replace it in low risk breast cancer.

I can see the appeal in post chemo CR setting where you’re treating potential residual microscopic disease, i.e. the role of radiation in breast cancer for like the last 50 years.

There are so many real clinical problems to solve in cancer. Lumpectomy + adjuvant RT is curative in 90+% of patients with low risk disease. Why are we still funding research on solutions in search of problems? Take the win and move on.

 

[Palex80]

WBRT is probably overkill for this concept. Maybe 30 Gy / 5fx PBI instead?

That would be an excellent trial idea.

 

[radiation]

Lumpectomy is so effective and well tolerated feels like it’d be (almost) crazy to try to replace it in low risk breast cancer.

I can see the appeal in post chemo CR setting where you’re treating potential residual microscopic disease, i.e. the role of radiation in breast cancer for like the last 50 years.

This is exactly the trial. Lumpectomy not as perfect as you describe - lots of debate about positive margins, re-resections etc throughout the years. Women hate re-resections chasing a margin. Sentinel nodes were also very well tolerated, but if a procedure is not adding anything then why do it? I am sure there are many pts that would love organ sparing approach and complete avoid going under anesthesia/surgery

 

[randomname2018]

There are so many real clinical problems to solve in cancer. Lumpectomy + adjuvant RT is curative in 90+% of patients with low risk disease. Why are we still funding research on solutions in search of problems? Take the win and move on.

But have you seen the price of parking?

 

[evilbooyaa]

I think for a patient who is being planned for NAC (like TNBC and HER2+) anyways, sure, I'd be happy to. This is going to get extrpaolated to Luminal A patients IRL and it's going to be a **** show.

Only Rad Oncs would look at the past 30 years of trials trying to omit RT, find a trial omitting a lumpectomy (and allowing for RT WBI alone) and call it useless. Self-flagellators.

Every single modality should look at de-escalating.

50% of patients were T2, 18% of patients were N1. This is not a trial of all T1N0 patients. Would whole heartedly support a ph III further evaluating before we roll it out as standard clinical practice.