Breast-conserving surgery without irradiation in early breast cancer

In the PRIME II study, the omission of radiotherapy for older patients (>65 years) with low-risk breast cancer led to more locoregional recurrences (9.5% versus 0.9%) (Hazard ratio, 10.4; 95% confidence interval, 4.1-26.1, P < 0.001).[1] Overall survival was unaffected, possibly owing to adjuvant hormonal therapy, effective salvage therapy, and competing causes of mortality prevalent in this demographic.[2] This patient population may be offered partial breast irradiation as a validated, cost-effective, and better-tolerated alternative to whole breast radiotherapy. Various single-fraction intraoperative radiation schedules and hypofractionated schedules[3] have emerged that diminish the risk of local recurrence.[4] This is important since locoregional recurrences have additional implications such as higher mastectomy rates (6.3% versus 3.2%),[5] and more recurrence anxiety. Genomic profiling or gene signatures may further refine patient selection in the future.[6] Until that happens, omitting radiotherapy in this group of patients remains a complex decision, if brachytherapy, hypofractionation, or intraoperative radiotherapy are readily available. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.