Comparative effectiveness of radiotherapy for early‐stage hormone receptor‐positive breast cancer in elderly women using real‐world data

Ali, Askal Ayalew; Tawk, Rima; Xiao, Hong; Campbell, Ellen; Montero, Alberto J.; Mogos, Muluberhan; Diaby, Vakaramoko

doi:10.1002/cam4.1904

Cited by 8 publications

(5 citation statements)

References 23 publications

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Section: Introductionmentioning

confidence: 99%

“…Moreover, some observational studies and a large propensity-score study showed a decreased risk of death for elderly breast cancer patients treated with RT ( 10 - 12 ). Ali et al analysed a total of 5,688 patients, 1,549 (27.23%) of whom treated with hormone therapy (HT) alone and 4,139 (72.77%) treated with RT plus HT after BCS ( 12 ). In the Propensity Score-matched sample, patients who had received RT plus HT revealed a 38% lower risk of death compared with patients who were treated with only HT ( 12 ).…”

Section: Introductionmentioning

confidence: 99%

“…Ali et al analysed a total of 5,688 patients, 1,549 (27.23%) of whom treated with hormone therapy (HT) alone and 4,139 (72.77%) treated with RT plus HT after BCS ( 12 ). In the Propensity Score-matched sample, patients who had received RT plus HT revealed a 38% lower risk of death compared with patients who were treated with only HT ( 12 ). Additional data have been recently showed in a National Cancer Database study ( 13 ).…”

Section: Introductionmentioning

confidence: 99%

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Altered fractionation in radiation therapy for breast cancer in the elderly: are we moving forward?

Pinzi¹,

Fariselli²,

Jereczek‐Fossa³

2020

Transl Cancer Res TCR

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Radiotherapy is a pivotal treatment for treating breast cancer. However, its role in the management of elderly patients is still under debate. Some authors suggest be avoided after surgery for early stage, some others advocate its adoption. For breast cancer treatment different schedules are used both for whole and partial breast irradiation, in adjuvant as well as definitive setting. Which one is better for elderly patients is a controversial topic. Numerous studies focused on both moderate or extreme hypofractionated irradiation have been published. However, only few addressed the topic on elderly patient population. The data on hypofractionated radiotherapy showed that for whole breast, locoregional and post-mastectomy treatment, this approach is a valid option reporting similar efficacy and toxicity to the standard fractionation. Also accelerated partial breast irradiation for patients with favourable early stage disease represents a viable option allowing for de-escalation by targeting radiation dose to the part of breast tissue at highest recurrence risk. Undoubtedly, for frail and elderly patients a short course of radiotherapy could increase their adherence and the quality of life. In the same manner, the preoperative approach has been applied for both whole and partial breast irradiation, allowing for more precise target delineation compared to the post-surgical one, eventually leading to a smaller treatment volume, to less geographical missing and possibly to a lower radiation-induced toxicity. Some more long-term results could make us more confident in prescribing adjuvant or preoperative partial breast irradiation. These approaches could be the most appropriate treatment for elderly patients, potentially preserving quality of life and increasing the tolerability to the irradiation.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Altered fractionation in radiation therapy for breast cancer in the elderly: are we moving forward?

Pinzi¹,

Fariselli²,

Jereczek‐Fossa³

2020

Transl Cancer Res TCR

View full text Add to dashboard Cite

show abstract

“…Many previous observational studies addressed the omission of radiotherapy after BCS in older patients. Some advocate that radiotherapy may be omitted [20][21][22][23], whereas others state that it is unsafe due to a higher risk of locoregional recurrence [24][25][26] or even worse breast cancer specific and overall survival [25,[27][28][29]. Although different patient selections could play a role in the varying findings, results of these studies using conventional methods to adjust for confounding may have been biased to some extent.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of radiotherapy after breast-conserving surgery in older patients with T1-2N0 breast cancer

Boer

Bastiaannet

Glas

et al. 2019

Breast Cancer Res Treat

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Purpose In the Netherlands, radiotherapy after breast-conserving surgery (BCS) is omitted in up to 30% of patients aged ≥ 75 years. Although omission of radiotherapy is considered an option for older women treated with endocrine treatment, the majority of these patients do not receive systemic treatment following Dutch treatment guidelines. Therefore, the aim of this study was to evaluate the effect of omission of radiotherapy on locoregional recurrence risk in this patient population. Methods Patients aged ≥ 75 years undergone BCS for T1-2N0 breast cancer diagnosed between 2003 and 2009 were selected from the Netherlands Cancer Registry. To minimize confounding by indication, hospital variation was used to assess the impact of radiotherapy-use on locoregional recurrence risk using cox proportional hazards regression. Hazards ratios with 95% confidence interval (CI) were estimated. Results Overall, 2390 patients were included. Of the patients with hormone receptor-positive breast cancer, 39.3% received endocrine treatment. Five-year incidences of locoregional recurrence were 1.9%, 2.8%, and 3.0% in patients treated at hospitals with higher (average radiotherapy-use 96.0%), moderate (88.0%), and lower radiotherapy-use (72.2%) respectively, and nine-year incidences were 2.2%, 3.1%, and 3.2% respectively. Adjusted hazard ratios were 1.46 (95% CI 0.77-2.78) and 1.50 (95% CI 0.79-2.85) for patients treated at hospitals with moderate and lower radiotherapy-use, compared to patient treated at hospitals with higher radiotherapy-use. Conclusions Despite endocrine treatment in only 39.3%, locoregional recurrence risk was low, even in patients treated at hospitals with lower radiotherapy-use. This provides reasonable grounds to consider omission of radiotherapy in patients aged ≥ 75 years with T1-2N0 breast cancer.

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“…Based on these findings, the U.S. national guidelines recommended omitting adjuvant radiotherapy after BCS for EBC women 70 years of age and older who are prescribed endocrine therapy [ 9 ]. However, whether radiotherapy is beneficial in the elderly is still a matter of debate, with results of recent studies using observational real-world data reporting higher mortality rates in those who did not receive radiotherapy after BCS [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Physicians’ Opinion on Intraoperative Radiotherapy as a Therapeutic De-Escalation Option in Older Women with Early Breast Cancer

et al. 2023

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Background: Intraoperative radiotherapy (IORT) is a therapeutic de-escalation option in older women with low-risk early breast cancer (EBC). A qualitative study was implemented to describe EBC physicians’ points of view on IORT as a de-escalation option. Methods: Recorded face-to-face and telephone semi-structured interviews were conducted among diverse physicians from seven French comprehensive cancer centers. Interview transcripts were grouped as corpus to construct a typology. Thematic analysis was performed. Results: Positions toward IORT were contrasted between the 16 participating physicians. Five fully supported IORT as a de-escalation option, four were not in favor, and seven had a more reserved or neutral opinion. Points of divergence concerned treatment efficacy, treatment duration, side effects and sequelae, psychological impact, compliance with adjuvant endocrine therapy, logistical constraints, financial cost, and availability of other techniques of partial breast irradiation. Physicians in favor of IORT emphasized direct benefits for the patient, and those against pointed the lack of specific guidelines, risk of lost opportunity in older women with long life expectancy, and challenges of shared decision making. Conclusions: Despite national policies to preserve cancer patients’ quality of life and increase their participation in medical decision making, therapeutic de-escalation using IORT is not consensual among physicians. Further efforts are needed to promote patient-centered care.

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Comparative effectiveness of radiotherapy for early‐stage hormone receptor‐positive breast cancer in elderly women using real‐world data

Cited by 8 publications

References 23 publications

Altered fractionation in radiation therapy for breast cancer in the elderly: are we moving forward?

Altered fractionation in radiation therapy for breast cancer in the elderly: are we moving forward?

Effectiveness of radiotherapy after breast-conserving surgery in older patients with T1-2N0 breast cancer

Physicians’ Opinion on Intraoperative Radiotherapy as a Therapeutic De-Escalation Option in Older Women with Early Breast Cancer

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