Study: Early-stage breast cancer surgery may not be necessary after chemo, radiation

Editor's Note

Some patients with early-stage breast cancer who achieve a complete response to pre-surgical chemotherapy and radiation may safely avoid surgery, according to a March 27 announcement from The University of Texas MD Anderson Cancer Center.

The report details a Phase II trial, published in JAMA Oncology, finding that none of 31 patients with a pathologic complete response (pCR) experienced cancer recurrence after a median follow-up of 55.4 months. The overall survival rate was 100%. 

Researchers enrolled 50 women over age 40 with early-stage triple-negative or HER2-positive breast cancer. Participants had a residual breast lesion less than two centimeters after completing standard chemotherapy, as determined by imaging. A single image-guided vacuum-assisted core biopsy (VACB) was performed. If no disease was found, surgery was omitted, and patients proceeded to standard whole-breast radiotherapy. Among the 31 patients identified with pCR, none experienced recurrence, and no significant biopsy-related adverse events occurred.

Presented at the Society of Surgical Oncology 2025 Annual Meeting, the study is said to be the first modern prospective trial to assess the omission of surgery in early-stage breast cancer patients who respond well to chemotherapy. The trial’s success builds on prior research indicating that advanced chemotherapy agents have increased pCR rates, researchers write. Combining these high response rates with selective VACB and precise histologic processing allows for better assessment of which patients may not need surgery.

However, researchers emphasize that additional studies are necessary before omitting surgery becomes a standard practice. Meanwhile, the multicenter trial has been expanded to include 100 patients and is being further investigated in South Korea.