The addition of radiotherapy to breast-conserving surgery improves survival for elderly patients with early breast cancer

Abstract

PurposeTo evaluate whether adjuvant radiotherapy (RT) after breast-conserving surgery (BCS) was associated with better survival among elderly (≥70 years) breast cancer patients with T1-2N0 and estrogen receptor (ER) positive disease.MethodsWe included patients who met the inclusion criteria between 2010 and 2014 from the Surveillance, Epidemiology, and End Results program. Patients were subdivided into three groups based on surgery and RT: BCS alone, BCS plus RT, and refusal of RT. The primary outcomes were breast cancer-specific survival (BCSS) and overall survival (OS). Chi-squared tests, Kaplan–Meier method, and Multivariate Cox regression analysis were used for statistical analysis. Propensity score matching (PSM) was performed to minimize the potential selection bias.ResultsA total of 26586 patients were included in this analysis. The median follow-up was 66 months. Of these patients, 15591 (58.6%) patients received RT, RT was recommended but not performed due to patient refusal for 1270 (4.8%) patients, and RT was not recommended for 9725 (36.6%) patients. The 5-year BCSS was 98.3% for patients receiving RT, 97.1% for patients refusal of RT, and 96.4% for patients not recommended RT (P<0.001). The 5-year OS was 88.6% for patients receiving RT, 77.6% for patients who refused RT, and 72.1% for patients not recommended RT (P<0.001). Multivariate Cox regression analyses showed that patients who received adjuvant RT after BCS had significantly better BCSS (hazard ratio [HR] 0.523, 95%confidence interval [CI] 0.447-0.612, P<0.001) and OS (HR 0.589, 95%CI 0.558-0.622, P<0.001) compared to those without RT. A total of 7721 pairs of patients were matched successfully between those with and without RT using PSM. The results also showed that patients who received RT after BCS had significantly better BCSS (HR 562, 95%CI 0.467-0.676, P<0.001) and OS (HR 0.612, 95%CI 0.0.575-0.652, P<0.001) compared to those without RT.ConclusionsThese data suggest that individual counseling is important for treatment decision-making in elderly breast cancer patients with T1-2N0 and ER-positive disease. Given the relatively lower toxicity of modern RT techniques, adjuvant RT should be recommended in patients with high life expectancy.

The effect of adjuvant radiotherapy after breast-conserving surgery in elderly women with T1-2N0 estrogen receptor-negative breast cancer

“…In our study, the proportion of patients aged ≥ 70 years with T1-T2N0 ER-negative breast cancer who received RT after BCS was not significantly different from 2010 to 2015 (P = 0.182). Moreover, we found that age, marital status, tumor grade, and HER2 status were the main factors associated with RT decision, which is consistent with previous clinical practice [ 15 , 16 ]. Numerous studies have demonstrated that older breast cancer patients with ER-negative tumors have higher rates of recurrence and breast cancer-specific mortality [ 17 – 19 ].…”

Molecular subtypes of breast cancer predicting clinical benefits of radiotherapy after breast-conserving surgery: a propensity-score-matched cohort study

“…This finding indicates that the benefits of OS from post-BCS RT extend beyond just the luminal subtypes and apply to basal-like and HER2-enriched breast cancers. The lack of tumor control in basal-like and HER2-enriched breast cancers did not diminish the OS benefits of post-BCS RT, suggesting that RT has a robust effect on prolonging survival in post-BCS patients [ 5 , 44 , 45 ]. It is a proven fact that post-BCS RT has noticeable positive effects on breast cancer patients, with both breast-cancer-specific survival and OS significantly improved even in elderly patients (age ≥ 70 years) [ 44 ].…”

“…The lack of tumor control in basal-like and HER2-enriched breast cancers did not diminish the OS benefits of post-BCS RT, suggesting that RT has a robust effect on prolonging survival in post-BCS patients [ 5 , 44 , 45 ]. It is a proven fact that post-BCS RT has noticeable positive effects on breast cancer patients, with both breast-cancer-specific survival and OS significantly improved even in elderly patients (age ≥ 70 years) [ 44 ]. Furthermore, the benefits of RT on OS were not dependent on irradiation volume, as similar benefits were observed in patients who underwent accelerated partial breast irradiation and those who received whole breast RT [ 46 ].…”