# Omitting Radiotherapy after Breast-Conserving Surgery in Luminal A Breast Cancer

Source: https://onco.cc/key-papers/paper-lumina-n-engl-j-med-2023/  
OnCo record `paper-lumina-n-engl-j-med-2023` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Published report from the LUMINA trial registered as NCT01791829, in New England Journal of Medicine (2023), chosen as the most cited paper whose own text cites the registry id.

## Summary

Background: Adjuvant radiotherapy is prescribed after breast-conserving surgery to reduce the risk of local recurrence. However, radiotherapy is inconvenient, costly, and associated with both short-term and long-term side effects. Clinicopathologic factors alone are of limited use in the identification of women at low risk for local recurrence in whom radiotherapy can be omitted. Molecularly defined intrinsic subtypes of breast cancer can provide additional prognostic information.

Methods: We performed a prospective cohort study involving women who were at least 55 years of age, had undergone breast-conserving surgery for T1N0 (tumor size <2 cm and node negative), grade 1 or 2, luminal A-subtype breast cancer (defined as estrogen receptor positivity of ≥1%, progesterone receptor positivity of >20%, negative human epidermal growth factor receptor 2, and Ki67 index of ≤13.25%), and had received adjuvant endocrine therapy. Patients who met the clinical eligibility criteria were registered, and Ki67 immunohistochemical analysis was performed centrally. Patients with a Ki67 index of 13.25% or less were enrolled and did not receive radiotherapy. The primary outcome was local recurrence in the ipsilateral breast. In consultation with radiation oncologists and patients with breast cancer, we determined that if the upper boundary of the two-sided 90% confidence interval for the cumulative incidence at 5 years was less than 5%, this would represent an acceptable risk of local recurrence at 5 years.

Results: Of 740 registered patients, 500 eligible patients were enrolled. At 5 years after enrollment, recurrence was reported in 2.3% of the patients (90% confidence interval [CI], 1.3 to 3.8; 95% CI, 1.2 to 4.1), a result that met the prespecified boundary. Breast cancer occurred in the contralateral breast in 1.9% of the patients (90% CI, 1.1 to 3.2), and recurrence of any type was observed in 2.7% (90% CI, 1.6 to 4.1).

Conclusions: Among women who were at least 55 years of age and had T1N0, grade 1 or 2, luminal A breast cancer that were treated with breast-conserving surgery and endocrine therapy alone, the incidence of local recurrence at 5 years was low with the omission of radiotherapy. (Funded by the Canadian Cancer Society and the Canadian Breast Cancer Foundation; LUMINA ClinicalTrials.gov number, NCT01791829.).

Indexed on Europe PMC as PubMed record 37585627 (DOI 10.1056/nejmoa2302344). Its abstract cites the registry id NCT01791829, which is how it was matched to this trial; no figure has been checked by an editor.

## Fields

- Kind: Key paper
- Last checked: 2026-09-22
- Tags: europepmc-ingest
- Journal: New England Journal of Medicine
- Year: 2023
- DOI: 10.1056/nejmoa2302344
- Authors: Whelan TJ, Smith S, Parpia S, et al.
- What it means: This is the paper Europe PMC returns for registry id NCT01791829 with the most citations, so it is the natural first reading for anyone following the LUMINA trial. Read the abstract above alongside the trial page and the registry entry; the record was linked automatically and its figures have not been checked by hand.
- Caveats: Matched to the trial by the registry id cited in the Europe PMC record; the summary reproduces the record's abstract and no figure has been verified against the full paper.

## Sources

- N Engl J Med 2023: https://doi.org/10.1056/nejmoa2302344
- PubMed: https://pubmed.ncbi.nlm.nih.gov/37585627/
- Europe PMC: https://europepmc.org/article/MED/37585627
- ClinicalTrials.gov NCT01791829: https://clinicaltrials.gov/study/NCT01791829

## Connected records

- trials: [LUMINA](https://onco.cc/trials/lumina/)
- journals: [New England Journal of Medicine](https://onco.cc/journals/nejm/)

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