Controversial issues in radiotherapy after breast-conserving surgery for early breast cancer in older patients: a systematic review

Tang, Liuwei; Matsushita, Haruo; Jingu, Keiichi

doi:10.1093/jrr/rry071

Cited by 15 publications

(10 citation statements)

References 40 publications

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“…6 It is complex to manage a benefit/risk balance for elderly breast cancer patients, because it is necessary to weigh life expectancy, competing risk of death and treatment-related toxicity. 9 Although only a few deaths resulted from breast cancer in the C9343 trial, 7 our analysis of Surveillance, Epidemiology, and End Results Program (SEER) data between 2004 and 2014 showed that, among patients aged ≥70, approximately 20% of deaths that occurred within 5 years after cancer diagnosis were attributable to breast cancer. Noteworthy, the risk of dying from breast cancer also significantly increases with aging, especially for those aged ≥80.…”

Section: Discussionmentioning

confidence: 97%

“…8 Nonetheless, the importance and necessity of RT after BCS in the elderly population remains considerably controversial. 9 In 2005, the National Comprehensive Cancer Network (NCCN) clinical practice guidelines included a recommendation that RT may be omitted in patients aged ≥70 who had ER+, clinically node-negative, T1 tumors and had received endocrine therapy. 4 Despite this, RT use in routine practice only declined minimally.…”

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confidence: 99%

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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: 97%

mentioning

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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“…A randomized trial study by Holli et al found that PRT does not increase OS in breast cancer patients 15. Similarly, Tang et al also suggested PRT should be considered with caution for female elderly breast cancer patients 6. However, another study conducted by Cosar et al found that elderly women with early breast cancer could significantly benefit from PRT 16.…”

Section: Discussionmentioning

confidence: 99%

“…A meta-analysis suggested radiotherapy could reduce the 10-year risk of any first recurrence and the 15-year risk of breast cancer death 3. The role of PRT is still controversial when the tumor size is ≤5 cm and the number of positive lymph nodes is between one and three 4-6. Certain studies suggest that radiotherapy may impair the quality of life in elderly patients 7, 8.…”

Section: Introductionmentioning

confidence: 99%

Effects of Postoperative Radiotherapy in Early Breast Cancer Patients Older than 75 Years: A Propensity-Matched Analysis

et al. 2019

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Background: Currently, there is still some controversy regarding whether early breast cancer patients with a tumor size of ≤5 cm and 1-3 positive lymph nodes should undergo postoperative radiotherapy (PRT). Materials and Methods: We obtained data from the Surveillance, Epidemiology, and End Results (SEER) 18 database. Then, we conducted propensity score matching (PSM), according to the radiotherapy record. The Kaplan-Meier and Cox regression analysis were conducted to explore prognostic factors in breast cancer. Results: A total of 6,777 patients aged 75+ years old were eligible and 2,361 patients were included after PSM. We found PRT could improve patient overall survival (OS) (P = 0.01, hazard ratio [HR] = 0.88, 95% confidence interval [CI], 0.80-0.97). Subgroup analysis revealed PRT could improve OS in patients with hormone receptor positive (HR+) (P = 0.001, HR = 0.84, 95% CI, 0.76-0.94) or white patients (P =0.004, HR = 0.86, 95% CI, 0.77-0.95). Conclusions: PRT may benefit for elderly women with early breast cancer, especially in HR+ patients or white patients. These findings may inform future optimized options whether elderly female patients with early breast cancer should undergo postoperative radiotherapy.

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“…In a population-based study, the omission of RT after BCS even in the elderly and those who had an increased risk of recurrence was not acceptable because of the increasing potential of local recurrence and breast cancer mortality [32,33]. In older patients with low-risk breast cancer, RT in addition to hormonal therapy decreased the probability of local recurrences but did not improve OS [34].…”

Section: Discussionmentioning

confidence: 99%

Saving the Breast Saves the Lives of Breast Cancer Patients

Akbari

Khayamzadeh

Moradi

et al. 2020

International Journal of Surgical Oncology

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Introduction. Surgery has been known as the procedure of choice for breast cancer management since 1700 years before Christ. Nowadays, breast-conserving surgery and mastectomy are performed in selected cases with specific clinical criteria. Here, we compare these two procedures for breast cancer patients with variable features in Cancer Research Center, Tehran, as a single institution experience. Methods. In this 25-year follow-up retrospective cohort study, we identified breast cancer patients who had undergone breast-conserving therapy or mastectomy. Disease-free survival and overall survival were evaluated using Kaplan–Meier survival analysis and the log-rank test between the two groups. A p value less than 0.05 was considered statistically significant. Results. A total of 3358 breast cancer patients, including 61% breast-conserving therapy and 39% mastectomy cases were identified, with a mean follow-up time of 94 months. The overall survival and disease-free survival of all cases were significantly better in breast-conserved patients, particularly in early-stage breast cancer with favorable clinical, pathological, and biological features. Ten-year disease-free survival and overall survival in breast-conserving therapy and mastectomy cases were 74%, 88% and 58%, 80%, respectively. Conclusion. Breast-conserving surgery and radiation therapy prove to be an appropriate treatment option for breast cancer patients in terms of overall survival and disease-free survival when indicated.

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Controversial issues in radiotherapy after breast-conserving surgery for early breast cancer in older patients: a systematic review

Cited by 15 publications

References 40 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

Effects of Postoperative Radiotherapy in Early Breast Cancer Patients Older than 75 Years: A Propensity-Matched Analysis

Saving the Breast Saves the Lives of Breast Cancer Patients

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