Dr Jagsi on Factors for RT Omission After Breast-Conserving Surgery in Early Breast Cancer

"We should be considering factors that lower the absolute risk of locoregional recurrence because [the use of] radiation therapy [after breast-conserving surgery] is likely based on all of the meta analyses that the early breast cancer trials collaborative group have conducted [showing] radiation is likely to [lower] the overall risk of recurrence."

Reshma Jagsi, MD, DPhil, the Lawrence W. Davis Professor and chair of the Department of Radiation Oncology at Emory University School of Medicine, discusses factors that could influence the omission of radiation therapy (RT) following breast-conserving surgery in patients with early-stage breast cancer. Jagsi highlighted these factors in a presentation at the 42nd Annual Miami Breast Cancer Conference®.

Although data have long demonstrated that RT can significantly reduce the risk of locoregional recurrence following surgery, identifying patients with a sufficiently low absolute recurrence risk is critical in determining whether omission is appropriate, Jagsi begins.

Jagsi explains that based on meta analyses conducted by the Early Breast Cancer Trialists' Collaborative Group, RT reduces the relative risk of local recurrence by approximately two-thirds in the overall early-stage breast cancer population. However, the absolute benefit varies depending on patient and tumor characteristics. In cases where the absolute risk of recurrence is low, the potential benefit of RT may be minimal, making omission a reasonable option, she explains

Several key factors predict a lower risk of in-breast tumor recurrence and may support RT omission, according to Jagsi. Age is a significant determinant, she says, as older patients—particularly those 70 years of age or older—associated with lower recurrence rates. Additionally, estrogen receptor (ER)–positive disease is associated with a more favorable prognosis, particularly in the absence of high-risk pathologic features. Tumors that exhibit indolent biological behavior, as assessed by genomic assays, further contribute to a reduced risk of recurrence.

For patients with early-stage, node-negative, ER-positive breast cancer, particularly those with favorable tumor biology, the omission of RT may be a viable option, Jagsi says. The goal is to identify a cohort of patients in whom the absolute recurrence risk remains sufficiently low, even in the absence of RT, thereby avoiding unnecessary treatment and potential toxicities.

Jagsi emphasizes that the decision to omit RT should be individualized, taking into account tumor biology, patient preferences, and competing health risks. Advances in genomic profiling and risk stratification tools continue to refine patient selection, enabling more personalized treatment approaches. Future research should focus on further validating biomarkers and refining clinical algorithms to optimize decision-making in this setting.