[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-440231-105":3,"detail-sidebar-cat-0-en-105":80,"doc-detail-440231-en":130},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":73,"head_meta":75,"extra_data":77,"updated_unix":79},105,"en","radiotherapy-omission-in-low-risk-hormone-receptorpositive-breast-cancer-insights-from-a-korean-single-center-cohort","Radiotherapy omission in low-risk hormone receptor–positive breast cancer - insights from a Korean single-center cohort","","Editorial discussion of radiotherapy omission after breast-conserving surgery for low-risk hormone receptor–positive breast cancer, highlighting evidence that even “lowest-risk” groups generally experience higher ipsilateral local recurrence without radiotherapy. Focuses on a Korean single-center cohort study using strict clinicopathologic selection, endocrine therapy adherence, and propensity score matching, reporting very low recurrence with limited early follow-up. Emphasizes caution due to single-institution retrospective design, small non-radiotherapy sample size, short follow-up, potential lower real-world endocrine adherence, and the need for long-term outcomes.",{"@graph":14,"@context":72},[15,34,55],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/radiotherapy-omission-in-low-risk-hormone-receptorpositive-breast-cancer-insights-from-a-korean-single-center-cohort/440231/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/radiotherapy-omission-in-low-risk-hormone-receptorpositive-breast-cancer-insights-from-a-korean-single-center-cohort/440231.png","ImageObject",300,407,{"name":42,"@type":43},"Danger 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[https://doi.org/10.3857/roj.2025.00836](https://doi.org/10.3857/roj.2025.00836)  \nRadiotherapy omission in low-risk hormone receptor–positive breast cancer: insights from a Korean single-center cohort  \nHaeyoung Kim  \nDepartment of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea  \nReceived: December 1, 2025  \nAccepted: December 8, 2025  \nCorrespondence:  \nHaeyoung Kim  \nDepartment of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea Tel: +82-2-3410-2612  \n[E-mail: haeyoung0131.kim@samsung](E-mail: haeyoung0131.kim@samsung).  \ncom, [hykim0131@skku.edu](hykim0131@skku.edu)[ ](hykim0131@skku.edu)ORCID:  \n[https://orcid.org/0000-0003-1808-7573](https://orcid.org/0000-0003-1808-7573)  \nBreast-conserving surgery (BCS) followed by radiotherapy has long represented the standard of care for early-stage breast cancer, supported by randomized trials and meta-analyses that have demonstrated substantial reductions in ipsilateral breast tumor recurrence and modest improvements in breast cancer mortality [1,2]. As our understanding of tumor biology has evolved and endocrine therapy has become more widely adopted, interest has grown in identifying subsets of patients with truly low-risk, hormone receptor (HR)–positive disease for whom postoperative radiotherapy might be omitted. However, despite decades of research, no clinicopathological subgroup has been conclusively demonstrated to achieve a sufficiently low recurrence risk to omit the local control benefit of radiotherapy. Evidence from the Early Breast Cancer Trialists’ Collaborative Group meta-analysis, the NSABP B-21 trial, CALGB 9343, and PRIME II consistently demonstrated that even among patients considered lowest risk, omitting radiotherapy is associated with increased local recurrence than with radiotherapy [1-4]. Accordingly, although treatment de-escalation is an important goal, radiotherapy omissions continue to require thoughtful consideration.  \nIn this issue of Radiation Oncology Journal, Song et al. [5] presented an important early Korean report evaluating radiotherapy omission in a narrowly selected, low-risk cohort. Using their single-center hospital’s database, the investigators identified postmenopausal women with pT1N0/Nx, grade 1–2, HR-positive/human epidermal growth factor receptor 2–negative tumors and Ki-67 ≤ 20% who underwent BCS and endocrine therapy. Among the 742 eligible patients treated between 2010 and 2020, 707 received radiotherapy and 35 did not. With a median follow-up of less than 6 years in theomission group, no locoregional recurrences were observed, and the overall recurrence rates remained low in both cohorts after propensity score matching. These findings suggest that within highly structured clinical settings, radiotherapy omission may be feasible for a very small, stringently selected subset of patients with biologically favorable disease. In Song et al.’s cohort [5], routine preoperative magnetic resonance imaging, strict clinicopathologic selection, and high adherence to endocrine therapy likely contributed to excellent outcomes, despite omitting radiotherapy.  \nDespite these favorable outcomes, caution should be exercised. This study was conducted at a single tertiary institution, which limits its generalizability across diverse clinical environments. The retrospective design also introduced selection bias that could not be fully eliminated, as radiotherapy decisions are influenced by age, comorbidity, and physician judgment. Another important limitation was the small number of patients who did not receive radiotherapy (n = 35). Although no recurrences were observed, the omission cohort was too small to draw firm conclusions, and the absence of  \nCopyright © 2025 The Korean Society for Radiation Oncology  \n","cbCainHzCvqlJvxJ","https://ap.wps.com/l/cbCainHzCvqlJvxJ","pdf",94698,"English","# Background\n## Evidence for recurrence risk without radiotherapy\n# Korean single-center cohort findings\n## Patient selection and outcomes\n# Limitations and cautions\n## Generalizability, retrospective bias, sample size, follow-up duration\n## Importance of endocrine adherence and long-term recurrence risk","[{\"question\":\"为什么在低风险HR阳性乳腺癌中仍难以完全省略术后放疗？\",\"answer\":\"既往meta分析与多项临床研究显示，即使在被认为最低风险的人群中，不放疗通常仍会带来更高的局部复发率，从而削弱放疗的局部控制获益。\"},{\"question\":\"韩国单中心队列研究采用了哪些关键条件来评估放疗可省略性？\",\"answer\":\"研究纳入绝经后女性，肿瘤分期与分级较低、HR阳性且HER2阴性、Ki-67≤20%，并要求接受乳腺癌保乳手术与内分泌治疗；同时强调严格的临床病理选择与良好的内分泌治疗依从性。\"},{\"question\":\"作者对该研究结论提出了哪些主要限制和风险提示？\",\"answer\":\"局限包括单中心、回顾性研究设计可能导致选择偏倚；未接受放疗的样本量较小且随访时间较短，难以支持长期安全性；此外现实场景中内分泌治疗依从性可能下降，而HR阳性疾病存在较长期复发风险。\"}]","Radiotherapy omission in low-risk hormone receptor–positive breast cancer - insights from a Korean single-center cohort | PDF",1790691566]