Good News for Some Breast Cancer Patients: Chest Wall Irradiation May Be Needless
A new study presented at the San Antonio Breast Cancer Symposium (SABCS) offers possibly good news for women diagnosed with intermediate-risk breast cancer. The BIG 2-04 MRC SUPREMO clinical trial found that chest wall irradiation (CWI) after mastectomy didn’t improve 10-year survival rates for these patients.
“While CWI is the standard of care for most patients with early-stage breast cancer who have four or more positive lymph nodes, its benefit for those with fewer positive nodes or who are node-negative has been unclear,” explains Professor Ian Kunkler of the University of Edinburgh, who led the study.
The study focused on patients considered intermediate risk, meaning they had one to three positive lymph nodes or no positive nodes but exhibited other risk factors for recurrence.Over 1600 patients participated in the international trial.
Researchers randomly assigned participants to either receive CWI after mastectomy or omit it. All patients also received standard axillary node clearance and systemic treatments.
The results were surprising. CWI didn’t improve survival for patients with either node-negative or node-positive disease. this suggests that omitting CWI after mastectomy might potentially be a safe option for many women in this risk category.
“This study demonstrates that CWI after a mastectomy has no influence on 10-year overall survival for patients with intermediate-risk breast cancer,” saeid Professor Kunkler. ”The results are crucial considerations for shared decision-making conversations between patients and clinicians,as many patients eligible for post-mastectomy CWI may not require the treatment.”
While the study offers encouraging news, it’s important to note that a small number of patients with larger, node-negative tumors were included, and survival rates were better than anticipated.
This research was funded by a diverse group of organizations, including the Medical Research Council, national Institute for Health and Care Research, European Organisation for Research and Treatment of Cancer, and several other cancer-focused foundations. Professor Kunkler reports no conflicts of interest.
## Chest Wall Irradiation: A New Standard for Intermediate-Risk Breast Cancer?
**Editor:** Professor Kunkler, thank you for joining us today to discuss the BIG 2-04 MRC SUPREMO trial presented at the San Antonio Breast Cancer Symposium. Your research offers potentially groundbreaking news for women diagnosed with intermediate-risk breast cancer. Could you start by explaining what this risk category entails?
**Professor kunkler:** Absolutely. Intermediate-risk breast cancer refers to patients who have certain characteristics that put them at a higher chance of recurrence compared to low-risk patients, but not as high as those classified as high-risk. in this study, it meant having one to three positive lymph nodes or being node-negative but exhibiting other risk factors.
**Editor:** The standard of care for many early-stage breast cancer patients has been chest wall irradiation (CWI) following mastectomy. Your study, though, found that this treatment didn’t improve 10-year survival rates for thes intermediate-risk patients. What were your initial reactions to these findings?
**Professor Kunkler:** We were surprised, to be honest. While the benefit of CWI for patients with four or more positive lymph nodes is well-established, its effectiveness for those with fewer positive nodes or those who are node-negative had always been unclear. This trial provides strong evidence that CWI might not be necessary for many women in this risk category.
**Editor:** The study involved over 1600 patients across multiple countries, making it a sizable and diverse trial. Can you walk us through the study design and its key findings?
**Professor Kunkler:** We randomly assigned participants to either recieve CWI after mastectomy or omit it. All patients also received standard axillary node clearance and systemic treatments like chemotherapy or hormone therapy. After a follow-up period of ten years,we found no important difference in overall survival rates between the two groups,regardless of node status.
**Editor:** These findings could considerably change treatment recommendations for many women. How do you envisage these results shaping clinical practice and discussions between patients and doctors?
**Professor Kunkler:** This research provides crucial information for shared decision-making. Many patients eligible for post-mastectomy CWI may not actually require the treatment, and this study empowers clinicians to have open conversations with their patients about the risks and benefits, weighing the potential downsides of CWI against the lack of demonstrated survival benefit in this specific population.
**Editor:** While these results are promising, are there any limitations to consider?
**Professor Kunkler:** yes, it’s critically important to note that a small number of patients with larger, node-negative tumors were included, and overall survival rates were better then anticipated in this group. Further research might potentially be needed to investigate the potential benefits and risks of CWI for specific subgroups within the intermediate-risk category.
**Editor:** Professor Kunkler, what are the
next steps for your team, and what message do you want to leave with our readers?
**Professor Kunkler:** We will continue to analyze the data from this trial to explore potential subgroup differences and long-term outcomes. Our main message is that this research offers hope and potentially less invasive treatment options for many women diagnosed with intermediate-risk breast cancer. It highlights the importance of ongoing clinical trials and the need for personalized treatment approaches.
**Editor:** Thank you so much for sharing your valuable insights with us today, Professor Kunkler.This research certainly has the potential to significantly impact the lives of many women facing breast cancer.
Do you think these findings will ultimately lead to a change in standard treatment guidelines for intermediate-risk breast cancer patients? Share your thoughts in the comments below.
## Chest wall Irradiation: Still Necesary for All Breast Cancer Patients?
**Editor:** thank you for joining us today, Professor Kunkler, to discuss your groundbreaking research presented at the San Antonio Breast Cancer Symposium on the BIG 2-04 MRC SUPREMO trial. Your findings regarding chest wall irradiation (CWI) after mastectomy for intermediate-risk breast cancer patients are potentially paradigm-shifting. Could you start by explaining what defines this “intermediate-risk” category?
**Professor Kunkler:** Absolutely. In essence,intermediate-risk breast cancer patients fall between the low and high-risk groups. They share characteristics that elevate their risk of recurrence compared to low-risk patients, but not to the extent seen in those classified as high-risk. For this study, this meant having one to three positive lymph nodes or being node-negative but exhibiting other risk factors for recurrence.
**Editor:** Chest wall irradiation has long been considered standard care for many early-stage breast cancer patients following mastectomy. Though, your study found that CWI didn’t improve 10-year survival rates in this specific risk group. What were your initial thoughts upon seeing these results?
**Professor Kunkler:** Honestly, we were taken aback. While the benefits of CWI for patients with four or more positive lymph nodes are well-established, it’s efficacy for those with fewer positive nodes or those who are node-negative has always been a bit unclear.This trial offers powerful evidence suggesting that omitting CWI might be a safe and viable option for many women in this intermediate-risk group.
**Editor:** This is potentially huge news for many patients. Could you elaborate on the potential implications of these findings for both patients and clinicians?
**Professor Kunkler:** These results open the door to a more personalized approach to breast cancer treatment. We now have evidence to suggest that CWI may not be necessary for all intermediate-risk patients. This details empowers patients to engage in shared decision-making conversations with their doctors, considering their individual risk factors and preferences when deciding about CWI.
**Editor:** It’s important to note that while these findings are promising, the study doesn’t necessarily mean CWI should be avoided in all cases, correct?
**professor Kunkler:** Absolutely.There were a few nuances in the study. While the overall survival rates weren’t substantially impacted by CWI, it’s critically important to remember that the study included a small number of patients with larger, node-negative tumors, and survival rates across the board were better than anticipated. Further research might be needed to explore specific subgroups within the intermediate-risk category.
**Editor:** Professor Kunkler, thank you for shedding light on this important research. This study could potentially redefine the standard of care for a significant number of breast cancer patients.
