Role of radiotherapy in women over the age of 65 after breast conserving surgery for breast cancer: A 5-year retrospective study

Clement, Zackariah; McLeay, William; Hoffmann, Clive; Shin, Peter; Kiu, Andrew; Eaton, Michael

doi:10.3233/bd-180340

Cited by 5 publications

(2 citation statements)

References 21 publications

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“…The survival curve analysis showed that RT failed to improve the OS and BCSS (BCSS: P=0.108, OS: P=0.050) of patients in the 65-69-year-old subgroup. Our research results support those of previous studies (12,(22)(23)(24). For example, Clement et al found that women aged >65 years had a similar incidence of LR in RT and non-RT groups (5.8% vs. 5%, P=0.838) (22).…”

Section: Discussionsupporting

confidence: 92%

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Prognostic role of radiotherapy in low-risk elderly breast cancer patients after breast-conserving surgery: a cohort study

Lai¹,

Han²,

Zhang³

et al. 2022

Gland Surg

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Background: Previous research suggested that radiotherapy (RT) had a small absolute benefit in patients with low-risk breast cancer over the age of 65. To reduce the patient's treatment burden and cost, as well as the damage to normal tissue, this study sought to explore the prognostic role of RT after breast-conserving surgery (BCS) in elderly patients. Methods: Patients who were aged ≥65 years, stage T1N0M0, and estrogen receptor/progesterone receptor positive (ER + /PR + ) were included in this study. Age, marital status, histology, race, grade, human epidermal growth factor receptor 2 (HER2), subtype, treatment method, and survival were also collected from the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2015. We compared overall survival (OS) and breast cancer-specific survival (BCSS) before and after propensity score matching (PSM) in the patients who underwent BCS with or without RT. Kaplan-Meier method and Cox proportional hazards regression analyses were used in our study. Results: The data of 3,623 patients were analyzed in this study. Among them, 2,851 (78.69%) patients had received RT. The multivariate analyses before PSM showed that RT resulted in better OS [hazard ratio (HR) 0.51, 95% confidence interval (CI): 0.42-0.62, P<0.001], and BCSS (HR 0.40, 95% CI: 0.27-0.58, P<0.001).The multivariate analyses after PSM (n=1,538) confirmed that patients who received RT (n=769) had a longer survival time than those who did not (n=769) (OS: HR 0.73, 95% CI: 0.57-0.95, P=0.018; and BCSS: HR 0.57, 95% CI: 0.35-0.93, P=0.025). The survival analysis showed that patients receiving RT had a better OS (P=0.028) and BCSS (P=0.016) than those who did not receive RT. However, there were no significant differences in patients' OS and BCSS with or without RT across the different age subgroups (P>0.05). Conclusions: In our study, patients who received RT had a longer survival time. However, the age subgroup analysis showed that RT did not have any survival benefit in elderly patients with T1N0M0 and ER + /PR + breast cancer. Furthermore, at the age of 65-69 years, the P value for OS approached 0.05, which suggests that the decision to administer RT in this patient group should be made based on each patient's condition.

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Section: Discussionsupporting

confidence: 92%

“…Our research results support those of previous studies (12,(22)(23)(24). For example, Clement et al found that women aged >65 years had a similar incidence of LR in RT and non-RT groups (5.8% vs. 5%, P=0.838) (22). Similarly, Wu et al (23) found that postoperative RT did not improve BCSS rates compared to no RT (P=0.134).…”

Section: Discussionsupporting

confidence: 90%

Prognostic role of radiotherapy in low-risk elderly breast cancer patients after breast-conserving surgery: a cohort study

Lai¹,

Han²,

Zhang³

et al. 2022

Gland Surg

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Intraoperative radiotherapy: An alternative to whole‐breast external beam radiotherapy in the management of highly selective breast cancer: A SEER database analysis

Sun,

Lu,

Liang

et al. 2024

Cancer Medicine

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ObjectiveThis study aimed to verify if intraoperative radiotherapy (IORT) can achieve the same survival outcome as whole‐breast external beam radiotherapy (EBRT) in early breast cancer after breast‐conserving surgery (BCS), and to explore the suitable candidates that can safely receive IORT after BCS.MethodsEligible post‐BCS patients who received IORT or EBRT were included in the Surveillance, Epidemiology and End Results (SEER) database from 2010 to 2018. Risk factors that affected 5‐year overall survival (OS) or breast cancer specific survival (BCSS) were identified by Cox proportional hazards regression analysis. Clinical characteristics, OS, and BCSS were comparatively analyzed between the two treatment modalities.ResultsThe survival analysis after propensity score matching confirmed that patients who received IORT (n = 2200) had a better 5‐year OS than those who received EBRT (n = 2200) (p = 0.015). However, the two groups did not differ significantly in 5‐year BCSS (p = 0.381). This feature persisted even after multivariate analyses that took into account numerous clinical characteristics. Although there was no significant difference in BCSS between different subgroups of patients treated with IORT or EBRT, patients over 55 years of age, with T1, N0, non‐triple negative breast cancers, hormone receptor‐positive, and histologic grade II showed a better OS after receiving IORT.ConclusionIn low‐risk, early‐stage breast cancer, IORT was not inferior to EBRT considering 5‐year BCSS and OS. Considering the equivalent clinical outcome but less radiotoxicity, IORT might be a reasonable alternative to EBRT in highly selective patients undergoing BCS.

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A Real-World US Study of Recurrence Risks using Combined Clinicopathological Features in HR-Positive, HER2-Negative Early Breast Cancer

et al. 2022

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Aim: To assess invasive disease-free survival (IDFS) and distant relapse-free survival (DRFS) in hormone receptor-positive, HER2-negative early breast cancer with combined clinicopathological criteria from monarchE, a phase III study of abemaciclib. Methods: US electronic health records were used to compare outcomes between high-risk (≥4 lymph nodes, or 1–3 lymph nodes and grade 3, tumor ≥5 cm, or Ki-67 ≥20%) versus nonhigh-risk groups using Kaplan–Meier methods and Cox regression models. Results: The high-risk group (n = 557) was at higher risk for IDFS and DRFS events than the nonhigh-risk group (n = 3471). IDFS events (hazard ratio: 3.07; 95% CI: 2.45–3.83) and DRFS events (hazard ratio: 3.15; 95% CI: 2.49–3.97) were significantly higher for the high-risk group. Conclusion: Risk of recurrence was three-times greater in the high-risk group, highlighting the need for better therapies.

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Role of radiotherapy in women over the age of 65 after breast conserving surgery for breast cancer: A 5-year retrospective study

Abstract: XRT in women over the age of 65 did not decrease the risk of LR. Adjuvant XRT in older women should be offered to selective patients with high risk patient and tumour factors.

Cited by 5 publications

References 21 publications

Prognostic role of radiotherapy in low-risk elderly breast cancer patients after breast-conserving surgery: a cohort study

Prognostic role of radiotherapy in low-risk elderly breast cancer patients after breast-conserving surgery: a cohort study

Intraoperative radiotherapy: An alternative to whole‐breast external beam radiotherapy in the management of highly selective breast cancer: A SEER database analysis

A Real-World US Study of Recurrence Risks using Combined Clinicopathological Features in HR-Positive, HER2-Negative Early Breast Cancer

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