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

Abstract

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.

What do patients and health care professionals view as important attributes in radiotherapy decisions? Input for a breast cancer patient decision aid

“…Swallowing complaints/oesophagus regional Swallowing complaints/in case of regional RT Other Changes in the effects if also chemotherapy given information should be communicated varied between all interviewed persons. Although in some countries endocrine therapy is offered to patients with a very low risk of recurrence, affecting the balance on advantages and disadvantages of choosing for RT and/or endocrine therapy this is not clinical practice in the Netherlands [3] and was therefore not included in this study.…”

“…Clinical trials, such as the PRIME II trial [1], the BASO II trial [2], and the EUROPA trial (NCT04134598), evaluate the omission and/or replacement of endocrine therapy with breast radiotherapy (RT) for these patients. In the Netherlands, where endocrine therapy is not offered for these very low risk invasive breast cancer, the TOP-1 trial is being conducted in which also the local breast RT is omitted after breast conserving surgery in patients above 70 years of age (NL5983) [1,3].…”

Effect of adjuvant radiotherapy in elderly patients with breast cancer

“…Also Kunkler et al stated, that the 5-year ipsilateral breast tumor recurrence rate is probably low enough for women older than 65 years to forgo radiotherapy after BCS [7]. De Boer et al recently showed that recurrence risk in elderly patients aged � 75 years with T1-2N0 breast cancer was low, even without radiotherapy [33].…”

Geriatric Breast Cancer: Staging, Molecular Surrogates, and Treatment. A Review & Meta-analysis

“…All the studies in the present review included patients who were using different therapies such as surgery, chemotherapy, radiotherapy, hormonal/endocrine therapy, adjuvant therapy, neoadjuvant therapy. Surgery was the primary method of treating BC in most of the studies [56,57,60,62,[64][65][66]. While a single study reported patients using adjuvant and neoadjuvant therapy [54].…”