Radiation therapy after breast-conserving surgery in women 70 years of age and older: How wisely do we choose? Journal Article

Authors: Downs-Canner, S.; Zabor, E. C.; Wind, T.; Cobovic, A.; McCormick, B.; Morrow, M.; Heerdt, A.
Article Title: Radiation therapy after breast-conserving surgery in women 70 years of age and older: How wisely do we choose?
Abstract: Background: Despite data from randomized trials supporting omission of radiation therapy (RT) for women ≥ 70 years of age with T1, estrogen receptor-positive (ER+) tumors undergoing breast-conserving therapy (BCT), RT usage remains high. We reviewed our institutional experience to determine if risk factors for local recurrence or comorbidities influenced use. Methods: Women ≥ 70 years of age with T1, ER+, human epidermal growth factor receptor 2-negative (HER2−) tumors undergoing BCT in 2010–2012 were identified from a prospectively maintained database. Ten-year estimated mortality was calculated using the Suemoto index. The associations of clinicopathological features and mortality risk on receipt of RT were examined. Results: Overall, 323 patients with 327 cancers were identified. Median age was 75 years, median tumor size was 1 cm, and all were clinically node negative; 53.7% of patients received RT. RT usage decreased with age (73.6%, age 70–74 years; 49.5%, age 75–79 years; 33.3%, age 80–84 years; 10.7%, ≥ 85 years; p < 0.001). Within age groups, estimated mortality did not impact RT usage. On multivariable analysis, only younger age and larger tumor size were associated with RT use. Recurrence-free survival was 98% versus 93% with and without RT, respectively (p = 0.011). Those who received adjuvant radiation also had improved overall survival (92% vs. 89%), although this effect did not reach statistical significance (p = 0.051). Conclusion: Neither the factors associated with risk of local recurrence nor the estimated risk of death in 10 years were associated with use of adjuvant radiation in a large cohort of women ≥ 70 years of age with small ER+ breast cancers treated with breast-conserving surgery. © 2019, Society of Surgical Oncology.
Journal Title: Annals of Surgical Oncology
Volume: 26
Issue: 4
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2019-04-01
Start Page: 969
End Page: 975
Language: English
DOI: 10.1245/s10434-018-07151-4
PUBMED: 30737670
PROVIDER: scopus
Notes: Article -- Export Date: 1 April 2019 -- Source: Scopus
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MSK Authors
  1. Monica Morrow
    450 Morrow
  2. Alexandra S Heerdt
    86 Heerdt
  3. Emily Craig Zabor
    131 Zabor
  4. Beryl McCormick
    251 McCormick
  5. Tyler Rose Wind
    2 Wind