RETHINKING RADIATION IN EARLY BREAST CANCER: PROSPECT TRIAL HIGHLIGHTS

For those with early stage breast cancer, pre-surgery breast magnetic resonance imaging (MRI) could enhance patient wellbeing, improve treatment plans – and reduce the cost of treatment.

The primary results of the PROSPECT clinical trial, spotlighted in The Lancet (January 2024), was conducted by Breast Cancer Trials in Australia and led by Professor Bruce Mann.

Typically, radiation therapy following lumpectomy, or breast-saving surgery, is the norm to minimise the risk of cancer recurrence. However, the PROSPECT trial has challenged this standard by using MRI to identify low-risk early cancer patients, who might forego radiation. This innovative approach could revolutionise treatment approaches and yield considerable healthcare savings, estimated at $2,900 per patient.

The study involved 443 participants from 2011 to 2019 and used MRI to uncover additional cancerous areas in 11% of cases. With a median follow-up period of five years, only 1% of the 201 patients who skipped radiotherapy experienced a return of their cancer to the original site. In addition, only a small percentage of the entire trial cohort experienced local cancer recurrence – suggesting that detecting and treating the additional cancer areas was key for recurrence prevention.

The psychological benefits of the trial were also notable. Research presented at the 2023 San Antonio Breast Cancer Conference, found that patients bypassing radiotherapy reported less anxiety about their cancer returning and improved quality of life compared to those who underwent radiation.

“We are hopeful that this will pave the way for many of those diagnosed with early low-risk breast cancer to safely receive less intense treatment, with less physical and psychological impacts, while maintaining a very low risk of cancer recurrence,” said Prof Mann. He also underscored the need for a follow-up trial to confirm and expand on these encouraging findings.

Publication:

Mann, G. B., Skandarajah, A. R., Zdenkowski, N., Hughes, J., Park, A., Petrie, D., Saxby, K., Grimmond, S. M., Murugasu, A., Spillane, A. J., Chua, B. H., Badger, H., Braggett, H., Gebski, V., Mou, A., Collins, J. P., Rose, A. K. (2024). Postoperative radiotherapy omission in selected patients with early breast cancer following preoperative breast MRI (PROSPECT): primary results of a prospective two-arm study. The Lancet, 403(10423), P261-270. https://doi.org/10.1016/S0140-6736(23)02476-5