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Is Postmastectomy Radiation Necessary for Intermediate-Risk Breast Cancer?
Postmastectomy radiation therapy reduces local recurrence risk and prolongs survival in patients at high risk for breast cancer recurrence, including those with a high nodal burden, but what about in patients at intermediate risk for recurrence? To address this, investigators conducted an international, phase 3, randomized trial (SUPREMO) comparing chest-wall radiation with no radiation therapy among 1600 women who had undergone mastectomy for intermediate-risk breast cancer.
Approximately 30% of the women had stage T1N1 disease; 25% had T2N0 disease with grade 3 histology, lymphovascular invasion, or both; and 45% had T2N1 disease. Roughly 85% received chemotherapy (which consisted of anthracycline-based regimens, with or without a taxane), 80% endocrine therapy, and 20% trastuzumab. Median follow-up was 9.6 years.
Both treatment groups had a 10-year survival rate of 81%. Disease-free survival (76%) and distant metastasis–free survival (78%) were also similar between the groups.
Comment
Intermediate-risk patients derived no benefit from postmastectomy radiation therapy in this trial — perhaps because systemic therapy has become so effective as to render radiation unnecessary among patients with intermediate-risk breast cancer. The authors acknowledge that advances in systemic therapy may explain why the mortality rate was lower than expected in this trial, as was the number of chest-wall recurrences (only 29). Taken together, these findings suggest that with today's systemic therapies, we can safely de-escalate radiation therapy in patients with intermediate-risk breast cancer, sparing them unnecessary toxicity without compromising survival outcomes.
Citation(s)
Author:
Kunkler IH et al.
Title:
Ten-year survival after postmastectomy chest-wall irradiation in breast cancer.
Source:
N Engl J Med
2025
Nov
6; [e-pub].
(Abstract/FREE Full Text)
Empfohlen von
William J. Gradishar, M.D.