Radiation therapy utilization and outcomes for older women with breast cancer: Impact of molecular subtype and tumor grade

Haque, Waqar; Yuan, Denley Ming Kee; Verma, Vivek; Butler, E. Brian; Teh, Bin S.; Wiederhold, Lee; Hatch, Sandra S.

doi:10.1016/j.breast.2017.06.011

Cited by 15 publications

(7 citation statements)

References 37 publications

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“…Several previous studies outside of clinical trials have reported that adjuvant RT not only decreased the risk of ipsilateral breast cancer recurrence and secondary mastectomy, [20][21][22] but also improved breast cancer-specific survival among patients aged ≥70 and with Stage I/ER+ disease. [23][24][25] However, information on endocrine therapy, surgical margin status and comorbidity status was unavailable for these studies. In our study, with these factors and other prognosticrelated factors taken into account, elderly breast cancer patients who did not receive RT, including NCCN guideline eligible patients, were found to have higher mortality, even among those age ≥90.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Radiotherapy after breast‐conserving surgery for elderly patients with early‐stage breast cancer: A national registry‐based study

Wang

Meszoely

Pal

et al. 2020

Intl Journal of Cancer

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Considerable controversies exist regarding whether elderly patients with early-stage breast cancer receiving breast-conserving surgery (BCS) should forgo radiotherapy. We utilized the National Cancer Database to analyze data of 115 516 women aged ≥70 years, treated with BCS for T1-2N0-1M0 breast cancer between 2004 and 2014. Multivariable Cox proportional hazards model was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for mortality 3, 5 and 10 years after 90 days of BCS associated with radiotherapy. Patients who received no radiotherapy had a higher mortality rate than those who received radiotherapy (5-year survival rate: 71.2% vs 83.8%), with multivariable-adjusted HRs of 1.65 (95% CI: 1.57-1.72) for 3-year mortality, 1.53 (1.47-1.58) for 5-year mortality and 1.43 (1.39-1.48) for 10-year mortality. The association held even for patients ≥90 years. This association was observed in all strata by reasons for radiotherapy omission, receipt of endocrine therapy or chemotherapy, calendar period and other clinical characteristics, with 40% to 65% increased 5-year mortality for patients without radiotherapy. This positive association persisted when analyses were restricted to patients with T1N0 and estrogen-receptor-positive disease who had received endocrine therapy (5-year mortality: HR 1.47 [1.39-1.57]) and in propensity score weighted analyses. Our study shows, in routine practice, elderly patients who received no post-BCS radiotherapy had higher total mortality than those who received radiotherapy. These findings suggest that the current recommendation of omission of post-BCS radiotherapy for elderly women with early-stage breast cancer may need to be reconsidered, particularly for those without contraindication.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Radiotherapy after breast‐conserving surgery for elderly patients with early‐stage breast cancer: A national registry‐based study

Wang

Meszoely

Pal

et al. 2020

Intl Journal of Cancer

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“…The MMR deficient C71 cohort appears to be a favorable predominantly ductal BC subtype associated with TN molecular status. The association with radiation status was likely secondary to the fact that these tumors were predominantly TN (54%), and TN status is associated with higher radiation therapy (RT) utilization at 69.2% compared to 55.7% in ER+/HER2+, 57.1% in ER+/HER2-, and 65.6% in ER-/HER2+ patients 40 . There was no difference between markers of microsatellite instability and other metrics of tumor mutational burden between MMR groups, or any difference in associations between overall and progression free survival.…”

Section: Discussionmentioning

confidence: 99%

MMR Deficiency Defines Distinct Molecular Subtype of Breast Cancer with Unique Proteomic Networks and Variable Clinical Significance

Hacking

Chou

Baykara

et al. 2022

Preprint

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Mismatch repair (MMR) alterations are important prognostic and predictive biomarkers in a variety of cancer subtypes including colorectal and endometrial. However, in breast cancer (BC), the distinction and clinical significance of MMR is largely unknown. This may be due in part to the fact that genetic alterations in MMR genes are rare, and only seen to occur in around 3% of BCs. In the present study we analyzed TCGA data using a multi-sample protein-protein interactions (PPI) analysis tool, Proteinarium, and showed a distinct separation in the MMR deficient and intact specific networks. MMR deficient tumor specific networks have a highly connected cluster of histone genes, identified by unique PPI. We also found that distribution of MMR deficient breast cancer is more prevalent in HER2-enriched and triple-negative (TN) BC subtypes compared to luminal BCs. Poorer survival was seen in patients with HER2-enriched BCs with MMR deficiency, whereas an improved survival was seen in TNBCs with MMR deficiency. We recommend defining MMR deficient breast cancer by next generation sequencing (NGS) when any somatic mutation is detected in one of the 7 MMR genes found in our study. Our recommendations include labeling patients with variants of undetermined significance (VUS) as MMR deficient supported by findings from distinct clusters of patients based on our network analysis. MMR may have a role in guiding the use of immunotherapy for both TN as well as HER2-enriched BC.

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“…Other than the NSABP B-21 trial, all previously discussed trials mandated estrogen receptor positivity to evaluate radiation therapy omission in early stage invasive breast cancer ( 6 , 8 - 10 ). In an attempt to verify this difference amongst different breast cancer subtypes in elderly population; Haque et al assessed the radiation impact in elderly breast cancer women with T1N0M0 who underwent BCS and assessed breast cancer specific survival (BCSS) in each distinct subtype ( 15 ). Molecular biomarkers were grouped into four categories: ER+/HER2+, ER+/HER2−, ER−/HER2+ and ER−/HER2−.…”

Section: Her2-nue Negative and Triple Negative Diseasementioning

confidence: 99%

Controversies of radiation therapy omission in elderly women with early stage invasive breast cancer

Abu‐Gheida¹,

Hammoudeh

Abdel‐Razeq³

2020

Transl Cancer Res TCR

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Early stage invasive breast cancer is a disease that is prevalent in the elderly population. Data regarding radiation omission for elderly population is based on patients’ age. Given the increased life expectancy, data on individualizing treatment decisions based on multiple tumor and patient related factors other than age only is emerging. This review aims to analyze published data to provide clinicians with a general oversight on approaching this question.

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Radiation therapy utilization and outcomes for older women with breast cancer: Impact of molecular subtype and tumor grade

Cited by 15 publications

References 37 publications

Radiotherapy after breast‐conserving surgery for elderly patients with early‐stage breast cancer: A national registry‐based study

Radiotherapy after breast‐conserving surgery for elderly patients with early‐stage breast cancer: A national registry‐based study

MMR Deficiency Defines Distinct Molecular Subtype of Breast Cancer with Unique Proteomic Networks and Variable Clinical Significance

Controversies of radiation therapy omission in elderly women with early stage invasive breast cancer

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