Benefit of Radiotherapy after PCR & lumpectomy?

Phily

My wife was diagnosed with hormone positive stage 2 breast cancer around 8 months ago. She took an integrative approach to treatment including diet and lifestyle changes in addition to chemo. She was given a PCR following lumpectomy, her ongoing preventative treatments will include aromatise inhibitor and vitamin C infusions.

The questions we are trying to answer are what are the risk benefits of radiotherapy for someone in her situation.

The statistics we have found on radiotherapy results/benefits/dangers are generic (all types of breast cancer). Same with the risks.

We’d be very grateful of advice on where we can find more specific information as we are concerned that the risks outweigh the benefits.

Thanks

Phil

RocDocVic

https://csn.cancer.org/discussion/328058/benefit-of-radiotherapy-after-pcr-lumpectomy

Hi Phil. I have hormone negative and HER2 3+ Breast Cancer. I've had chemo therapy, and a lumpectomy. The tumor and surrounding tissue, as well as 3 lymph nodes that were removed during the lumpectomy, all tested negative for cancer cells. So I had a pCR pathology report too.

I will be having 15 sessions of whole breast radiation treatments, and possibly up to 5 sessions of Boost treatments to just the tumor area and incision zone. Radiation after a lumpectomy is highly recommend to prevent the return of the cancer via killing any remaining cancer cells that may not have been removed. Pesky little buggers that can hide out close by to the tumor.

As for the actual reduction in risk of return, ask your Radiologist Oncologist. They should be able to answer your questions. Personally I'm trying to reduce the risk of return as much as possible since HER2+ cancers tend to come back. I'm also taking HER2+ targeted chemo drugs for 6 months to make sure any circulating cells, or cells in the lymph system are killed off.

Best of luck.

RocDocVic

You might want to read this regarding Vitamin C and radiation treatments.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8863110/#:~:text=Since%20the%20main%20therapeutic%20effect,advised%20against%20it%20%5B6%5D.

Phily

Many thanks for the feedback 😊

My wife is in agreement with your approach. She also researched via the latest ChatGPT, I’ve copied the results below as they very clearly confirm the decision:

What are the chances of recurrence of early stage breast cancer treated with TCHP and radiation therapy vs no radiation therapy, where the patient had a lumpectomy and achieved a pathological complete response (PCR) to neoadjuvant therapy?

For a patient with early-stage breast cancer who has undergone a lumpectomy and achieved a pathological complete response (pCR) to neoadjuvant therapy (TCHP), the chances of recurrence are influenced by several factors, including whether radiation therapy is part of the treatment plan. Achieving pCR is a very favorable prognostic factor and generally indicates a lower risk of recurrence.

With Radiation Therapy

• Local Control and Recurrence: Radiation therapy is typically recommended following lumpectomy to address any microscopic residual disease and to decrease the risk of local recurrence. Studies have shown that even patients with pCR benefit from radiation therapy in terms of reducing local recurrence rates. For such patients, the local recurrence rate can be very low, often less than 5% over 10 years.
• Overall Benefit: The combination of achieving pCR and receiving radiation therapy provides excellent local control and contributes to the overall survival benefit. This integrated approach ensures that any potential residual cancer cells are eradicated, maintaining the effectiveness of the pCR.

Without Radiation Therapy

• Local Recurrence Risk: Omitting radiation therapy increases the risk of local recurrence, even in patients who have achieved pCR. While pCR significantly reduces the risk of recurrence, it does not entirely eliminate the possibility of local recurrence. In such cases, local recurrence rates can be higher, potentially ranging from 10-20% over 10 years.
• Considerations: The decision to omit radiation therapy might be considered in specific cases based on patient preference, comorbidities, or other factors. However, it is generally less common to omit radiation therapy in standard clinical practice for patients who have had a lumpectomy.

Clinical Evidence and Guidelines

• National Comprehensive Cancer Network (NCCN) Guidelines: These guidelines typically recommend radiation therapy after lumpectomy for early-stage breast cancer, regardless of the pCR status, to ensure maximum local control.
• Research Studies: Clinical studies have consistently shown that the addition of radiation therapy after lumpectomy reduces the risk of local recurrence, even in patients who achieve pCR with neoadjuvant therapy. For example, a study published in JAMA Oncology indicated that patients who achieved pCR but did not receive radiation therapy had higher rates of local recurrence compared to those who did receive radiation therapy.

Summary

• With Radiation Therapy: The chances of local recurrence are very low, often less than 5% over 10 years, given the excellent response to TCHP and pCR.
• Without Radiation Therapy: The risk of local recurrence is higher, potentially in the range of 10-20% over 10 years, even with pCR.

Ultimately, the decision to include radiation therapy should be made in consultation with the patient’s oncology team, considering the individual circumstances, potential benefits, and risks. The strong evidence supports the use of radiation therapy to maximize local control and reduce recurrence risk.

RocDocVic

https://csn.cancer.org/discussion/comment/1715598#Comment_1715598

Excellent and concise summary of information. Thanks for providing this. If I can keep the risk down to about 5% with radiation treatments then this makes it worthwhile compared to 10-20% as I just read on another site for HER2 positive Breast Cancer. So glad I've decided to do the whole breast radiation treatment plus Boost treatment. 20 days total. 15 days whole breast radiation treatment and 5 days Boost treatment. Again, thanks for posting this.