Long-term Impact of CALGB 9343 on Radiation Utilization

Squeo, Gabriella C.; Malpass, Jessica K.; Meneveau, Max O.; Balkrishnan, Rajesh; Desai, Raj Piyush; Lattimore, Courtney M.; Anderson, Roger T.; Showalter, Shayna L.

doi:10.1016/j.jss.2020.07.023

Cited by 10 publications

(6 citation statements)

References 20 publications

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“…However, despite this trial, long-term follow-up of this trial, and a change in the NCCN guideline to support RT omission, rates of RT have remained high for this cohort of older patients. 24,35,36 This study captured data on patients at a different period (2010-2018) from the study period (late 1990s to early 2000s) of the CALGB 9343 trial. Thus, advances in endocrine therapies and radiation treatments have occurred since the CALGB 9343 trial.…”

Section: Discussionmentioning

confidence: 99%

“…The NCCN guidelines were implemented after the landmark CALGB 9343 trial, which showed that adjuvant tamoxifen alone was a sufficient treatment for older patients with early-stage ER-positive disease, supporting the omission of adjuvant RT. However, despite this trial, long-term follow-up of this trial, and a change in the NCCN guideline to support RT omission, rates of RT have remained high for this cohort of older patients . This study captured data on patients at a different period (2010-2018) from the study period (late 1990s to early 2000s) of the CALGB 9343 trial.…”

Section: Discussionmentioning

confidence: 99%

“…Despite this evidence, there has been limited change in clinical practice and rates of RT use continue to be high. 21,24 outcomes included the factors associated with recurrence, potential subgroups that may benefit from SLNB or RT, and the trends in SLNB and RT use in this patient population over time.…”

Section: Introductionmentioning

confidence: 99%

“…Despite this evidence, there has been limited change in clinical practice and rates of RT use continue to be high. 21,24 This study aimed to retrospectively describe the use rates and association with disease recurrence of SLNB and RT in women aged 70 years or older with early-stage, ER-positive, ERBB2 JAMA Network Open | Oncology (formerly HER2)-negative, clinically node-negative breast cancer. Unlike previous studies on this topic, this study used highly annotated data derived from the cancer registry and electronic health record of a multisystem academic and community health care network to evaluate the feasibility of further deimplementation of SLNB and RT in this patient population.…”

Section: Introductionmentioning

confidence: 99%

“…Strong evidence generated by the Cancer and Leukemia Group B (CALGB) 9343 trial with long-term follow-up show that adjuvant therapy with tamoxifen citrate alone without the addition of RT is a feasible treatment strategy for older patients with early-stage, estrogen receptor (ER)–positive breast cancer. Despite this evidence, there has been limited change in clinical practice and rates of RT use continue to be high …”

Section: Introductionmentioning

confidence: 99%

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Outcomes After Sentinel Lymph Node Biopsy and Radiotherapy in Older Women With Early-Stage, Estrogen Receptor–Positive Breast Cancer

et al. 2021

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IMPORTANCE Overtreatment of early-stage breast cancer with favorable tumor biology in older patients may be harmful without affecting recurrence and survival. Guidelines that recommend deimplementation of sentinel lymph node biopsy (SLNB) (Choosing Wisely) and radiotherapy (RT) (National Comprehensive Cancer Network) have been published. OBJECTIVE To describe the use rates and association with disease recurrence of SLNB and RT in older women with breast cancer. DESIGN, SETTING, AND PARTICIPANTS This cohort study obtained patient and clinical data from an integrated cancer registry and electronic health record of a single health care system in Pennsylvania. The cohort was composed of consecutive female patients 70 years or older who were diagnosed with early-stage, estrogen receptor-positive, ERBB2 (formerly HER2)-negative, clinically node-negative breast cancer from January 1, 2010, to December 31, 2018, who were treated at 15 community and academic hospitals within the health system. EXPOSURES Sentinel lymph node biopsy and adjuvant RT. MAIN OUTCOMES AND MEASURES Primary outcomes were 5-year locoregional recurrence-free survival (LRFS) rate and disease-free survival (DFS) rate after SLNB and after RT. Secondary outcomes included recurrence rate, subgroups that may benefit from SLNB or RT, and use rate of SLNB and RT over time. Propensity scores were used to create 2 cohorts to separately evaluate the association of SLNB and RT with recurrence outcomes. Cox proportional hazards regression model was used to estimate hazard ratios (HRs). RESULTS From 2010 to 2018, a total of 3361 women 70 years or older (median [interquartile range {IQR}] age, 77.0 [73.0-82.0] years) with estrogen receptor-positive, ERBB2-negative, clinically nodenegative breast cancer were included in the study. Of these women, 2195 (65.3%) received SLNB and 1828 (54.4%) received adjuvant RT. Rates of SLNB steadily increased (1.0% per year), a trend that persisted after the 2016 adoption of the Choosing Wisely guideline. Rates of RT decreased slightly (3.4% per year). To examine patient outcomes and maximize follow-up time, the analysis was limited to cases from 2010 to 2014, identifying 2109 patients with a median (IQR) follow-up time of 4.1 (2.5-5.7) years. In the propensity score-matched cohorts, no association was found between

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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