Older breast cancer patients who receive less radiation have better cosmetic outcomes, but a slightly higher risk of disease recurrence, according to a new study. The researchers at the University of Texas MD Anderson Cancer Center are calling for a new treatment that’s gentler than whole breast radiation and provides more coverage than brachytherapy.

There is an array of different treatment options for breast cancer including lumpectomy plus WBI, lumpectomy plus brachytherapy, lumpectomy alone, mastectomy without radiation and mastectomy plus radiation. This is the first study to look at cosmetic and quality of life outcomes in older patients who undergo these treatments.

The researchers used Medicare claims to identify women 67 or older diagnostic with non-metastatic breast cancer in 2009 who received one of the five treatment options and were alive in 2015. A survey was sent to the women to evaluate their cosmetic satisfaction and a total of 498 responded.

Lumpectomy plus WBI was used as the reference group because it’s the most widely accepted standard of care. The research revealed that cosmetic satisfaction scores were higher for lumpectomy plus brachytherapy and lumpectomy alone, and those who received mastectomy plus radiation therapy had significantly worse cosmetic outcomes.

The patients also reported if their breast cancer had recurred, and six percent experienced recurrences in the lumpectomy-plus-brachytherapy and lumpectomy-alone groups compared to the lumpectomy-plus-WBI group.

This study expands on a previous study that was published in 2012 that found that accelerated partial breast irradiation brachytherapy is associated with a higher rate of later mastectomy, radiation-related toxicities and post-operative complications compared to WBI.

For the current study, the researchers used a different methodology to learn from the patient experience and determine their preferences. The evidence showed that the less radiation given, the better the long-term cosmetic satisfaction.

Going forward, they are launching a radiation study to determine the effect of external beam treatment to the area surrounding the tumor bed over two to two and a half weeks. They are also developing a decision-making tool for elderly breast cancer patients.

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