Brian Lawenda, Radiation Oncologist at Advocate Radiation Oncology, shared a post on LinkedIn:
“Rethinking Breast Cancer Treatment for Women Over 70: Could Radiation Alone Be Enough?
As a radiation oncologist, I have spent more than two decades helping women navigate complex treatment decisions in breast cancer. One question has become increasingly important:
Do all older women with early-stage, hormone receptor–positive breast cancer truly need years of endocrine therapy after lumpectomy?
For women aged 70 and older with small, low-grade, node-negative, ER-positive tumors, emerging evidence suggests that radiation therapy (RT) alone, delivered in just one to three weeks, may provide comparable long-term control to RT combined with endocrine therapy (ET), while avoiding the daily burden and side effects of systemic medication.
Why this matters:
- Endocrine therapy is effective but often poorly tolerated. Only about 50 to 75 percent of older patients complete the full five-year course because of side effects such as hot flashes, joint pain, fractures, and cognitive changes. Early discontinuation erases its benefit.
- Modern RT is fast, precise, and highly tolerable. Short-course radiation achieves excellent local control with minimal toxicity and near-perfect compliance.
This is not about abandoning endocrine therapy. It is about personalizing care. For some elderly women, short-course radiation may preserve quality of life and provide durable cancer control without the toxicity, cost, and compliance issues associated with long-term ET.
I review the full evidence, including randomized trials, NCCN guidance, toxicity profiles, and cost modeling, in my new Substack article:
The Great Breast Cancer De-Escalation Debate: Is Radiation Monotherapy the Next Step for Elderly Low-Risk Patients?”
You can read the full article here.
More posts featuring Brian Lawenda.