Sumit Kumar, Holder of the European Certification in Medical Oncology from the European Society for Medical Oncology (ESMO), shared on LinkedIn:
“Can We Really Skip Breast Radiotherapy?
LUMINA (2023), IDEA (2024/2026), and TOP-1 (ESMO 2026) are reshaping the debate on treatment de-escalation in early breast cancer. But low recurrence with endocrine therapy is not the same as omitting both treatments.
The real question: Are we reducing overtreatment – or accepting preventable local recurrences?”
Can We Safely Omit Breast Radiotherapy After Surgery?
Three prospective studies provide important insights into radiotherapy omission in selected patients with early-stage breast cancer.
LUMINA (NEJM, 2023)
Included 500 women aged ≥55 years with low-risk luminal A breast cancer. Patients received endocrine therapy without radiotherapy. The 5-year local recurrence rate was 2.3%, with overall survival of 97.2%.
IDEA (JCO, 2024)
Included 200 postmenopausal women aged 50–69 years with ER-positive, PR-positive, HER2-negative, node-negative breast cancer and an Oncotype DX score ≤18. Patients received endocrine therapy without radiotherapy. Five-year freedom from any recurrence was 99%.
TOP-1 (ESMO, 2026)
Included 792 women aged ≥70 years with low-risk, ER-positive, HER2-negative breast cancer. Neither radiotherapy nor endocrine therapy was administered. The 5-year invasive local recurrence rate was 14.8%.
Clinical Perspective
These findings highlight the importance of patient selection and endocrine therapy when considering radiotherapy omission. LUMINA and IDEA demonstrate low recurrence rates in carefully selected patients receiving endocrine therapy. TOP-1 highlights the higher local recurrence risk when both radiotherapy and endocrine therapy are omitted.
Treatment de-escalation should be guided by tumour biology, individual recurrence risk and patient preferences, rather than age alone.
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