Article Offers Evidence-Based Review of LUMINA Trial

Laws A, Brackstone M, Quan ML. Omitting Radiotherapy after Breast-Conserving Surgery in Luminal A Breast Cancer: The LUMINA study. J Am Coll Surg. 2024, in press.

Laws and coauthors described the elements of an evidence-based review webinar sponsored by the Canadian Association of General Surgeons. The review focused on the findings of the LUMINA trial that were published in the New England Journal of Medicine but also provided helpful data from other trials.

The main purpose of the reviewed trials was to develop advanced approaches for identification of low-risk breast cancers that can be treated with breast conservation and endocrine therapy.

In the LUMINA trial, genomic testing was used to identify LUMINAL A cancers that were successfully treated with endocrine therapy following breast conserving surgery. The trial reported exceptionally low rates of locoregional recurrence at 5 years of follow up.

The review noted that numerous exclusion criteria were used, the study population was older, and the rate of nonadherence to endocrine therapy was 17.3%. They also emphasized the fact that genomic testing is not available in many institutions that treat breast cancer patients.

Similar limitations were noted in trials using other methods to identify low-risk patients for endocrine therapy that also reported very low rates of locoregional recurrence.

The review team recommended that patient-centered approaches that carefully evaluate patient preferences and follow-up protocols that accurately document side effects and endocrine therapy adherence rates be chosen for management of these patient groups. Additional studies that supply longer term follow-up data are needed.