No, it’s not a @realDonaldTrump tweet. It’s the name of a breast cancer trial published this month in Lancet. The UK IMPORT LOW trial compared 3 breast radiation regimens all consisting of 15 treatments: (1) the standard 40 Gy to whole breast, (2) 36 Gy to the whole breast with 40 Gy to the tumor bed, and (3) 40 Gy to the tumor bed alone. The trial was beautifully designed in that it was big (n=2018), British, and bloody simple (breast tangents only). Ipsilateral breast recurrences were few and non-inferior among the 3 arms: 1.1% v 0.2% vs 0.5%. Interestingly, patients reported fewer breast changes (27% -> 15%) and less firmness (9% -> 5%) with partial versus whole breast treatment. A few key points: while this trial technically included node positive disease, very few pN+ patients were enrolled (<3%). Also, almost all had early stage ER/PR+, HER2- negative tumors. Our interpretation? For women with small resection cavities and large breasts, partial breast radiation should be a legitimate consideration to minimize late effects such as secondary malignancies. With the caveat of no reported cosmetic outcomes, this trial shows BIG RESULTS W SMALL FIELDS! #MPBGA


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