Radiotherapy as sole adjuvant treatment for older patients with low-risk breast cancer

Abstract

Partly as a result of screening, increasing numbers of older patients are presenting with 'low risk' breast cancer: tumours from which the likelihood of breast cancer death is minute; even so, these patients have a measurable risk of local recurrence if conservative surgery is not followed by some form of adjuvant treatment. However, it must be acknowledged that any such treatment has no detectable impact upon survival, and the value of all such interventions must be considered in the context of the individual patient's non-cancer life expectancy and the complex psychosocial factors that affect older patients. If no impact on survival can be expected and the risk of local recurrence is high enough to warrant some post-operative treatment, the most powerful agent in this respect is radiotherapy. Whilst adjuvant endocrine treatment is becoming increasingly accepted as monotherapy in low risk patients, we propose that radiotherapy should not be forgotten as an alternative which, with its attendant benefits of shorter duration and high compliance, may be more suitable for a number of patients.

Early-Stage Breast Cancer in the Elderly: Confronting an Old Clinical Problem

“…Besides radiotherapy hypofractionation, partial breast irradiation (PBI) has also been investigated intensively during this period [ 58 ]. In PBI, only the tumor region (surgical cavity with a 1 to 2 cm margin) is irradiated with higher single doses, thereby reducing the dose to the normal tumor-adjacent structures (up to a 50% decrease in the irradiated breast volume) and organs (e.g., heart and lungs), while simultaneously shortening the conventional 6 week daily radiotherapy course [ 68 69 ].…”

Patient views and correlates of radiotherapy omission in a population‐based sample of older women with favorable‐prognosis breast cancer

“…Patient responses were necessarily retrospective and may have been subject to recall bias. Finally, the current study evaluated patients' views of RT omission, but did not explore views concerning omitting endocrine therapy rather than RT . Nonetheless, we believe the current study offers a novel and clinically relevant view of decision making in older women with favorable‐prognosis breast cancer.…”

Tamoxifen with radiotherapy compared with Tamoxifen alone in elderly women with early-stage breast cancer treated with breast conserving surgery: A systematic review and meta-analysis

“…Two 2 Â 2 factorial design RCTs demonstrate that adjuvant monotherapy with either Tamoxifen alone or radiotherapy alone had similar effects on reduction of local recurrence compared with no adjuvant treatment [65,66]. Conversely, GBCG-V observed no difference between monotherapy with either Tamoxifen or radiotherapy compared with combined endocrine and radiotherapy, while BASO II observed increased local recurrence with monotherapy compared with combined therapy [64,66]. Based on these results, women who cannot tolerate or opt to omit endocrine therapy, may favor the inclusion of adjuvant radiotherapy.…”

“…These can lead to poor adherence and nonpersitence [63]. While several options for managing adverse effects exist, the option of omitting endocrine therapy has been proposed [60,64]. Two 2 Â 2 factorial design RCTs demonstrate that adjuvant monotherapy with either Tamoxifen alone or radiotherapy alone had similar effects on reduction of local recurrence compared with no adjuvant treatment [65,66].…”