Effect of adjuvant radiotherapy in elderly patients with breast cancer

Abstract

Background Radiotherapy (RT) is of critical importance in the locoregional management of early breast cancer. Although RT is routinely used following breast conserving surgery (BCS), patients may occasionally be effectively treated with BCS alone. Currently, the selection of patients undergoing BCS who do not need breast irradiation is under investigation. With the advancement of personalized medicine, there is an increasing interest in reduction of aggressive treatments especially in older women. The primary objective of this study was to identify elderly patients who may forego breast irradiation after BCS without measurable consequences on local tumor growth and survival. Methods We analyzed 2384 early breast cancer patients aged 70 and older who were treated in 17 German certified breast cancer centers between 2001 and 2009. We compared RT versus no RT after guideline adherent (GA) BCS. The outcomes studied were breast cancer recurrence (RFS) and breast cancer-specific survival (BCSS). Low-risk patients were defined by luminal A, tumor size T1 or T2 and node-negative whereas higher-risk patients were defined by patients with G3 or T3/T4 or node-positive or other than Luminal A tumors. To test if there is a difference between two or more survival curves, we used the G p family of tests of Harrington and Fleming. Results The median age was 77 yrs (mean 77.6±5.6 y) and the median observation time 46 mths (mean 48.9±24.8 mths). 950 (39.8%) patients were low-risk and 1434 (60.2%) were higherrisk. 1298 (54.4%) patients received GA BCS of which 85.0% (1103) received GA-RT and only 15% (195) did not. For low-risk patients with GA-BCS there were no significant differences in RFS (log rank p = 0.651) and in BCSS (p = 0.573) stratified by GA-RT. 5 years RFS in both groups were > 97%. For higher-risk patients with GA-BCS we found a significant difference (p<0.001) in RFS and tumor-associated OS stratified by GA-RT. The results remain

Differences in clinicopathological characteristics, treatment, and survival outcomes between older and younger breast cancer patients

“…The high frequency at which our older cohort underwent MRM and not BCS, when compared to the younger patients (Fig. 2 ), is likely to be also a reflection of favoritism by HCP for the use of MRM to treat older BC patients as an alternative to BCS with radiotherapy, which can be inconvenient or harmful to patients who suffer from co-morbid conditions 40 , 41 .…”

Mucinous carcinoma in an octogenarian: Treatment and management of breast cancer in the elderly

“…Furthermore, no difference was found in ipsilateral breast tumor recurrence, BCSS, or overall survival between elderly patients with hormone receptor positive, node negative breast cancer who received breast conserving surgery with radiation or who received breast conserving surgery without radiation [37] . It has been reported that patients aged 70 years and older with low-risk early breast cancer breast conserving therapy can avoid breast irradiation with <3% chance of relapse [40] . Overall, these compiled studies point toward two potential views towards adjuvant radiation therapy: 1. adjuvant radiation therapy offers a potentially small benefit to prevent recurrence, but probably does not improve survival or 2. adjuvant radiation therapy offers no additional benefit when compared to other guideline adherent options.…”

Breast Cancer in Geriatric Patients: Current Landscape and Future Prospects

“…For elderly patients, radiation therapy can be recommended based on risk stratification; as it might be safely omitted for low-risk group. 61 Older patients carry higher risk of radiation-related toxicities due to accumulative effect related to heart and respiratory comorbidities. However, recent…”

“…For elderly patients, radiation therapy can be recommended based on risk stratification; as it might be safely omitted for low-risk group. 61 Older patients carry higher risk of radiation-related toxicities due to accumulative effect related to heart and respiratory comorbidities. However, recent advances in radiation therapy and utilization of modern organ sparing techniques, resulted in better understanding of underlying factors that may enhance toxicities.…”