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Recommendation
Radiation therapy after breast-conserving surgery – Older women
Discuss the benefits and risks of omitting radiation therapy after breast-conserving surgery in women over 70 years of age with very low risk of local recurrence and who are suitable and willing to take endocrine therapy for five years.
Consider omitting radiotherapy for women who (a) have had breast‑conserving surgery for invasive breast cancer with clear margins and (b) have a very low absolute risk of local recurrence (defined as women aged 65 and over with tumours that are T1N0, ER‑positive, HER2‑negative and grade 1 to 2) and (c) are willing to take adjuvant endocrine therapy for a minimum of 5 years
When considering omitting radiotherapy discuss the benefits and risks, including those in Table 5 (see NICE 2018 guideline for more details) , and explain that: (a) without radiotherapy, local recurrence occurs in about 50 women per 1,000 at 5 years, and with radiotherapy, occurs in about 10 women per 1,000 at 5 year; (b) overall survival at 10 years is the same with or without radiotherapy; (c) there is no increase in serious late effects if radiotherapy is given (for example, congestive cardiac failure, myocardial infarction or secondary cancer)
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How this guidance was developed
This recommendation was adapted from two source recommendations from the NICE 2018 guidelines (UK). The source recommendations were based on a systematic review of the evidence conducted to September 2017 and used wording (‘Consider’) indicative of a conditional recommendation and wording ('Discuss') indicative of the need for shared-decision making (using GRADE methods). The source recommendations were merged and simplified, and the threshold age changed from >65 years to >70 years to reflect the findings of the CALGB 9343 trial in the US and the use of this age in the NCCN (US) guidelines as a result of this study. The recommendation was considered probably generalisable to men, but the lack of certainty resulted in no change to the patient population.
Related guidance by topic
Radiation therapy after breast-conserving surgery – Older women
Recommendation
Discuss the benefits and risks of omitting radiation therapy after breast-conserving surgery in women over 70 years of age with very low risk of local recurrence and who are suitable and willing to take endocrine therapy for five years.
Principles in action
Patient-centred care
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Communication
This recommendation was adapted from two source recommendations from the NICE 2018 guidelines (UK). The source recommendations were based on a systematic review of the evidence conducted to September 2017 and used wording (‘Consider’) indicative of a conditional recommendation and wording ('Discuss') indicative of the need for shared-decision making (using GRADE methods). The source recommendations were merged and simplified, and the threshold age changed from >65 years to >70 years to reflect the findings of the CALGB 9343 trial in the US and the use of this age in the NCCN (US) guidelines as a result of this study. The recommendation was considered probably generalisable to men, but the lack of certainty resulted in no change to the patient population.
Related guidance by topic
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