Is Delayed Radiation Therapy Increasing Cancer Recurrence Risk?

Is it too late for radiation therapy?

Hello Dr.
Lai! Two years ago, I underwent a partial mastectomy on my left breast, and the tumor measured 2.6 cm with no lymph node involvement.
My Oncotype recurrence score was 18%, and my doctor mentioned that taking an aromatase inhibitor for five years could reduce it to 11%, so chemotherapy and radiation therapy were deemed unnecessary.
However, four months later, the hospital informed me that they had scheduled an appointment with a radiation oncologist for me.
It took three weeks after that for me to start my first radiation treatment, meaning I began radiation therapy four and a half months post-surgery, completing a total of twenty-one sessions.
I reviewed my medical records and found that my medical oncologist forgot to refer me to the radiation oncology department.
Since this is a teaching hospital where interns rotate every three months, it was the second medical oncologist who noticed I hadn't received radiation therapy and referred me for treatment.
My concern is: even though I am taking Arimidex, does the nearly five-month delay in starting radiation therapy increase the risk of recurrence? Thank you for your response, Dr.
Lai!

Fan Fan, 50~59 year old female. Ask Date: 2016/05/03

Dr. Lai Yicheng reply Oncology

Dear Madam,
Thank you for your letter.
I would like to respond as follows: The delay of nearly five months before starting radiation therapy has not been formally documented in the medical community regarding its impact on the likelihood of recurrence.
Please rest assured and complete your postoperative radiation therapy as soon as possible.
Sincerely,
Dr.
Lai Yi-Cheng
Department of Radiation Oncology
Changhua Hospital

Reply Date: 2016/05/03

More Info

The concern regarding the delay in radiation therapy after breast cancer surgery is a valid one, and it is essential to understand the implications of such delays on cancer recurrence risk. In your case, you underwent a partial mastectomy for a 2.6 cm tumor, and your oncotype score indicated an 18% risk of recurrence, which could be reduced to 11% with the use of an aromatase inhibitor like Arimidex. However, the delay of approximately five months before starting radiation therapy raises questions about its potential impact on your prognosis.

Research in oncology suggests that timely administration of adjuvant therapies, including radiation therapy, is crucial in reducing the risk of local recurrence in breast cancer patients. Radiation therapy is typically recommended after breast-conserving surgery to eliminate any residual cancer cells in the breast and surrounding tissues. Delays in initiating this treatment can theoretically allow for the potential growth of any remaining cancer cells, which could increase the risk of recurrence. However, the extent to which a delay affects recurrence risk can vary based on several factors, including tumor biology, the presence of hormone receptors, and individual patient characteristics.

In your situation, while the delay in radiation therapy is concerning, it is important to note that the oncotype score and the absence of lymph node involvement are favorable indicators. The oncotype score reflects the biology of the tumor and its likelihood of recurrence, and the fact that your lymph nodes were not affected is a positive prognostic factor. Additionally, the use of Arimidex is known to reduce the risk of recurrence in hormone receptor-positive breast cancer, which further supports your treatment plan.

It is also worth mentioning that the medical community does not have a definitive consensus on the exact impact of delayed radiation therapy on recurrence rates, as studies often focus on various factors influencing outcomes. Some studies suggest that delays of several weeks may not significantly alter the prognosis, while others indicate that longer delays could be detrimental. Therefore, while it is prudent to be concerned about the timing of your radiation therapy, it is equally important to consider the overall context of your treatment and the favorable factors at play.

In conclusion, while there is a theoretical risk that delaying radiation therapy could increase the chance of recurrence, your specific situation, including the favorable oncotype score and the absence of lymph node involvement, may mitigate this risk. It is crucial to maintain open communication with your healthcare team to monitor your progress and address any concerns you may have. Regular follow-ups and adherence to your prescribed medication will also play a significant role in your ongoing treatment and recovery. If you have further concerns, discussing them with your oncologist may provide additional reassurance and clarity regarding your treatment plan.

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