Small study finds some patients can de-escalate, skip cancer surgery, do only chemo and radiation

Not doing surgery and relying only on chemo is possible for some women, a new study says.

Dr. Henry Kuerer

According to a story by Roni Caryn Rabin in The New York Times some time ago, the research, an early-stage clinical trial, found that "a carefully selected group of patients who responded remarkably well to chemotherapy could skip surgery altogether."

About 60% of the test patients fit that category and went on to receive radiation treatment. They were still in remission, the article says, "after a median follow-up period of two years and two months," quoting Dr. Henry Kuerer, principal investigator of the study, which was published in Lancet Oncology.

"The elimination of surgery for invasive breast cancer is 'the ultimate form of breast-conserving therapy,'" the Times quotes him as saying.

Why skip an operation? It can lead to complications such as infections or lasting nerve pain.

Under any conditions, "there are always going to be people who would rather not have surgery," Rabin quotes Kuerer, professor of breast surgical oncology at the University of Texas Anderson Cancer Center in Houston.

The work, the story continues, "is part of an approach to cancer treatment called de-escalation — an effort to individualize treatment to a specific subtype of the disease, achieving the same results with less treatment and fewer interventions."

According to Karen Knudsen, chief executive officer of the American Cancer Society, "asking whether we can scale back surgery is a reasonable next consideration for the future of cancer care."

In a separate clinical trial, Kuerer is testing whether radiation is always necessary.

More information about choices when facing a life-threatening disease can be found in Rollercoaster: How a man can survive his partners breast cancer, a VitalityPress book that I, Woody Weingarten, aimed at male caregivers.