Nationwide trends in breast radiation therapy (RT) administration — including omission, whole breast RT (WBRT), and partial breast irradiation (PBI) — after breast-conserving surgery (BCS) in women ≥50 years with early-stage ER+/HER2− breast cancer, from 2014 to 2024 in the Netherlands (n=21,418).
RT omission rose sharply over time, especially in older patients (≥70 years): from 4.6% (2014–2016) to 55.3% (2020–2022), then dropping to 33.8% (2023–2024). In younger patients (50–69 years), omission rose modestly from 1.8% to 8.7%. PBI use surged from 4.3% to 51.9%, while WBRT without boost fell from 81.2% to 46.5%. Age was the strongest predictor of RT omission (OR 10.1).
- Only 3.5% of patients received endocrine therapy, which is unexpectedly low and may reflect data limitations or selection bias. - The spike in RT omission in older patients (2020–2022) is partly attributed to the TOP-1 trial, making it difficult to separate trial-driven from routine clinical practice changes. - Study design is descriptive/observational; causality and outcomes (e.g., recurrence rates) are not reported.
RT omission after BCS in early-stage, low-risk ER+ breast cancer is accelerating — particularly in patients ≥70 years, where one in three now skip RT entirely. Clinicians should distinguish between evidence-based de-escalation and premature adoption of trial protocols outside a controlled setting.
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