Implications of Omitting Radiation After Breast Conserving Surgery in Elderly Women With Low-risk Invasive Breast Cancer

Korah, M.P.; Sener, S.F.; Tripathy, Debu

doi:10.1016/j.ijrobp.2012.07.094

Cited by 6 publications

(9 citation statements)

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“…In contrast to the findings of RCTs, our study shows that the addition of radiotherapy was associated with improved OS of elderly patients diagnosed with early‐stage HR+ BC. These results were similar to those of other observational studies …”

Section: Discussionsupporting

confidence: 93%

“…Based on these trial results, the National Comprehensive Cancer Network (NCCN) guidelines recommend that adjuvant radiotherapy be omitted for patients 70 years and older with T1N0M0 ER+HER2‐negative BC . Conversely, findings from observational studies showed that the addition of radiotherapy after BCS was associated with improved survival of elderly women . These studies proposed that radiotherapy be considered a noteworthy aspect of a treatment plan for appropriately selected elderly patients and that age should not be the only factor to consider when making decisions about whether elderly patients with early‐stage BC should receive radiotherapy …”

Section: Introductionmentioning

confidence: 99%

“…9 Conversely, findings from observational studies showed that the addition of radiotherapy after BCS was associated with improved survival of elderly women. 10,11 These studies proposed that radiotherapy be considered a noteworthy aspect of a treatment plan for appropriately selected elderly patients and that age should not be the only factor to consider when making decisions about whether elderly patients with early-stage BC should receive radiotherapy. 10,11 Some of the differences between the results of randomized clinical trials (RCTs) and observational studies may derive from the limitations of these studies' designs.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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BackgroundRadiotherapy is the recommended treatment after breast‐conserving surgery (BCS) for early‐stage breast cancer (BC). However, there is no clear evidence whether radiotherapy after BCS improves the survival of elderly women diagnosed with early‐stage hormone receptor‐positive (HR+) BC. The aim of this study was to investigate the survival benefit associated with radiotherapy plus hormonal therapy vs hormonal therapy alone after BCS for early‐stage HR+ BC patients.MethodsUsing the Surveillance, Epidemiology, and End Results linked with Medicare data, we identified elderly (65 years and older) women diagnosed with early‐stage HR+ BC (2006‐2011) who received hormonal therapy with or without radiotherapy after BCS. A log‐rank test, Cox proportional hazards models, and propensity score matching were used to estimate the overall survival (OS) benefit associated with radiotherapy after BCS.ResultsOf the 5688 patients, there were 303 deaths from any cause. One hundred and eighty‐five (61%) of these deaths occurred in the hormonal therapy group, and 118 (39%) deaths occurred in the radiotherapy plus hormonal therapy group. The mean survival time in the radiotherapy plus hormonal therapy group was 5.32 ± 1.86 years compared with 4.92 ± 1.86 years in the hormonal therapy group. Based on the adjusted and propensity score matching analysis, patients in the adjuvant radiotherapy group had a lower risk of death compared with those who did not receive radiotherapy. Radiotherapy plus hormonal therapy decreased the risk of death by 32%. The effect estimates were similar in the adjusted and matched cohorts.ConclusionsRadiotherapy plus hormonal therapy resulted in a significant improvement in the OS of elderly women diagnosed with HR+ BC.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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“…On one hand, the results from randomized controlled trials suggest that the addition of radiation therapy after BCS does not improve the survival benefit for patients with less aggressive early stage breast cancer compared with those who were treated with hormonal therapy alone after BCS 4–8 . On the other hand, observational studies that reported the addition of radiation therapy after BCS had shown that the risk of death is reduced compared with no radiation and suggested the consideration of radiation therapy 9,10 .…”

Section: Introductionmentioning

confidence: 99%

Comparison of health utility weights among elderly patients receiving breast-conserving surgery plus hormonal therapy with or without radiotherapy

Ali

Xiao

Tawk

et al. 2016

Current Medical Research and Opinion

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“…Overall survival was improved by 15.5% at 5 years (88.6 vs 73.1); 23.3% at 10 years (65 vs 41.7%) and 19.6% at 15 years (39.6 vs 20%). Korah et al performed a similar study demonstrating improved cancer specific survival and overall survival with the addition of radiation to surgery in patients with stage T1/2, node negative, ER+ breast cancers [18]. They showed a similar absolute improvement of about 2% in breast cancer specific survival at 5 years which doubled to 4% at 8 years.…”

Section: Data On the Impact Of Rt In The Elderlymentioning

confidence: 89%

Radiation Therapy in the Elderly with Early Stage Breast Cancer: Review and Role of New Technology

Nichols¹

2014

J Nucl Med Radiat Ther

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In 2013, breast cancer affected 232,340 women in the US. Of these diagnoses, 52% were in women aged 65 and older. Although age is a risk factor for the development of breast cancer, women diagnosed at an older age generally have a more favorable prognosis due to often less aggressive tumor biology. Elderly women tend to have higher rates of hormone receptor positive tumors and also tumors with lower proliferative indices (Ki-67). Despite these favorable prognostic factors, breast cancer specific mortality has only decreased at a rate of 1.1% per year for women aged 75+ in comparison to 2.4% per year for women aged <50. It has been hypothesized that this is related to under-treatment of elderly patients due to increased comorbidities which can limit treatment options as well as social influences such as distance to treatment facilities and lack of transportation. Older women are less likely to be offered standard treatment including surgery, radiotherapy, chemotherapy and endocrine therapy regardless of their breast cancer stage.

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Implications of Omitting Radiation After Breast Conserving Surgery in Elderly Women With Low-risk Invasive Breast Cancer

Cited by 6 publications

References 0 publications

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

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

Comparison of health utility weights among elderly patients receiving breast-conserving surgery plus hormonal therapy with or without radiotherapy

Radiation Therapy in the Elderly with Early Stage Breast Cancer: Review and Role of New Technology

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