Radiotherapy: before or after surgery for breast cancer stages I-III?

This study examined whether radiotherapy treatment before surgery could improve disease-free survival, especially for patients with estrogen-receptor positive (ER+) breast cancer (dependent on the hormone estrogen for growth). This study concluded that radiotherapy before surgery improved disease-free survival.

For early stage breast cancer, surgery followed by radiotherapy is a common treatment option. Surgery can be a partial lumpectomy, which removes some breast tissue, or mastectomy, which removes all of the breast tissue. Radiotherapy can shrink tumor cells or prevent cancer recurrence. In some patients, radiotherapy may be given before surgery to help shrink the tumor. The long-term effects of pre-surgery radiotherapy are not clear. 

This study included information on 250,195 patients included in cancer databases. 2,554 patients had radiotherapy prior to surgery. 247,641 patients received radiotherapy after surgery.  Patients who underwent radiotherapy before surgery were followed for an average of 7 to 38.9 years. Other patients were followed for an average of 16.3 to 38.6 years. 94.4% of patients underwent a partial mastectomy (PM). 5.6% underwent a full mastectomy (FM).

In women who underwent a PM, the risk of developing a second cancer (different from the original) was 26% lower following pre-surgery radiotherapy. In women who underwent an FM, the risk was 52% lower.

Cancer-free survival following a PM was 12% higher following pre-surgery radiotherapy. Radiotherapy timing did not affect overall survival.

This study concluded that radiotherapy before surgery reduces the incidence of secondary primary tumors without decreasing overall survival rates. 

Discuss with your doctor the appropriate timing of radiotherapy.