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Carleton N, Nasrazadani A, Gade K, Beriwal S, Barry PN, Brufsky AM, Bhargava R, Berg WA, Zuley ML, van Londen GJ, Marroquin OC, Thull DL, Mai PL, Diego EJ, Lotze MT, Oesterreich S, McAuliffe PF, Lee AV. Personalising therapy for early-stage oestrogen receptor-positive breast cancer in older women. THE LANCET. HEALTHY LONGEVITY 2022; 3:e54-e66. [PMID: 35047868 PMCID: PMC8765742 DOI: 10.1016/s2666-7568(21)00280-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Age is one of the most important risk factors for the development of breast cancer. Nearly a third of all breast cancer cases occur in older women (aged ≥70 years), with most cases being oestrogen receptor-positive (ER+). Such tumours are often indolent and unlikely to be the ultimate cause of death for older women, particularly when considering other comorbidities. This Review focuses on unique clinical considerations for screening, detection, and treatment regimens for older women who develop ER+ breast cancers-specifically, we focus on recent trends for de-implementation of screening, staging, surgery, and adjuvant therapies along the continuum of care. Additionally, we also review emerging basic and translational research that will further uncover the unique underlying biology of these tumours, which develop in the context of systemic age-related inflammation and changing hormone profiles. With prevailing trends of clinical de-implementation, new insights into mechanistic biology might provide an opportunity for precision medicine approaches to treat patients with well tolerated, low-toxicity agents to extend patients' lives with a higher quality of life, prevent tumour recurrences, and reduce cancer-related burdens.
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Affiliation(s)
- Neil Carleton
- (N Carleton BS, Prof S Oesterreich PhD, P F McAuliffe MD, Prof A V Lee PhD) (S Beriwal MD, P N Barry MD), (N Carleton, Prof S Oesterreich, P F McAuliffe, Prof A V Lee); (A Nasrazadani MD, K Gade MD, Prof A M Brufksy MD, G J van Londen MD), (Prof R Bhargava MD), (D L Thull MS, P L Mai MD), (E J Diego MD, Prof M T Lotze MD, P F McAuliffe), (Prof M T Lotze), (Prof M T Lotze), (Prof S Oesterreich, Prof A V Lee), (Prof W A Berg MD, Prof M L Zuley MD); (O C Marroquin MD)
| | - Azadeh Nasrazadani
- (N Carleton BS, Prof S Oesterreich PhD, P F McAuliffe MD, Prof A V Lee PhD) (S Beriwal MD, P N Barry MD), (N Carleton, Prof S Oesterreich, P F McAuliffe, Prof A V Lee); (A Nasrazadani MD, K Gade MD, Prof A M Brufksy MD, G J van Londen MD), (Prof R Bhargava MD), (D L Thull MS, P L Mai MD), (E J Diego MD, Prof M T Lotze MD, P F McAuliffe), (Prof M T Lotze), (Prof M T Lotze), (Prof S Oesterreich, Prof A V Lee), (Prof W A Berg MD, Prof M L Zuley MD); (O C Marroquin MD)
| | - Kristine Gade
- (N Carleton BS, Prof S Oesterreich PhD, P F McAuliffe MD, Prof A V Lee PhD) (S Beriwal MD, P N Barry MD), (N Carleton, Prof S Oesterreich, P F McAuliffe, Prof A V Lee); (A Nasrazadani MD, K Gade MD, Prof A M Brufksy MD, G J van Londen MD), (Prof R Bhargava MD), (D L Thull MS, P L Mai MD), (E J Diego MD, Prof M T Lotze MD, P F McAuliffe), (Prof M T Lotze), (Prof M T Lotze), (Prof S Oesterreich, Prof A V Lee), (Prof W A Berg MD, Prof M L Zuley MD); (O C Marroquin MD)
| | - Sushil Beriwal
- (N Carleton BS, Prof S Oesterreich PhD, P F McAuliffe MD, Prof A V Lee PhD) (S Beriwal MD, P N Barry MD), (N Carleton, Prof S Oesterreich, P F McAuliffe, Prof A V Lee); (A Nasrazadani MD, K Gade MD, Prof A M Brufksy MD, G J van Londen MD), (Prof R Bhargava MD), (D L Thull MS, P L Mai MD), (E J Diego MD, Prof M T Lotze MD, P F McAuliffe), (Prof M T Lotze), (Prof M T Lotze), (Prof S Oesterreich, Prof A V Lee), (Prof W A Berg MD, Prof M L Zuley MD); (O C Marroquin MD)
| | - Parul N Barry
- (N Carleton BS, Prof S Oesterreich PhD, P F McAuliffe MD, Prof A V Lee PhD) (S Beriwal MD, P N Barry MD), (N Carleton, Prof S Oesterreich, P F McAuliffe, Prof A V Lee); (A Nasrazadani MD, K Gade MD, Prof A M Brufksy MD, G J van Londen MD), (Prof R Bhargava MD), (D L Thull MS, P L Mai MD), (E J Diego MD, Prof M T Lotze MD, P F McAuliffe), (Prof M T Lotze), (Prof M T Lotze), (Prof S Oesterreich, Prof A V Lee), (Prof W A Berg MD, Prof M L Zuley MD); (O C Marroquin MD)
| | - Adam M Brufsky
- (N Carleton BS, Prof S Oesterreich PhD, P F McAuliffe MD, Prof A V Lee PhD) (S Beriwal MD, P N Barry MD), (N Carleton, Prof S Oesterreich, P F McAuliffe, Prof A V Lee); (A Nasrazadani MD, K Gade MD, Prof A M Brufksy MD, G J van Londen MD), (Prof R Bhargava MD), (D L Thull MS, P L Mai MD), (E J Diego MD, Prof M T Lotze MD, P F McAuliffe), (Prof M T Lotze), (Prof M T Lotze), (Prof S Oesterreich, Prof A V Lee), (Prof W A Berg MD, Prof M L Zuley MD); (O C Marroquin MD)
| | - Rohit Bhargava
- (N Carleton BS, Prof S Oesterreich PhD, P F McAuliffe MD, Prof A V Lee PhD) (S Beriwal MD, P N Barry MD), (N Carleton, Prof S Oesterreich, P F McAuliffe, Prof A V Lee); (A Nasrazadani MD, K Gade MD, Prof A M Brufksy MD, G J van Londen MD), (Prof R Bhargava MD), (D L Thull MS, P L Mai MD), (E J Diego MD, Prof M T Lotze MD, P F McAuliffe), (Prof M T Lotze), (Prof M T Lotze), (Prof S Oesterreich, Prof A V Lee), (Prof W A Berg MD, Prof M L Zuley MD); (O C Marroquin MD)
| | - Wendie A Berg
- (N Carleton BS, Prof S Oesterreich PhD, P F McAuliffe MD, Prof A V Lee PhD) (S Beriwal MD, P N Barry MD), (N Carleton, Prof S Oesterreich, P F McAuliffe, Prof A V Lee); (A Nasrazadani MD, K Gade MD, Prof A M Brufksy MD, G J van Londen MD), (Prof R Bhargava MD), (D L Thull MS, P L Mai MD), (E J Diego MD, Prof M T Lotze MD, P F McAuliffe), (Prof M T Lotze), (Prof M T Lotze), (Prof S Oesterreich, Prof A V Lee), (Prof W A Berg MD, Prof M L Zuley MD); (O C Marroquin MD)
| | - Margarita L Zuley
- (N Carleton BS, Prof S Oesterreich PhD, P F McAuliffe MD, Prof A V Lee PhD) (S Beriwal MD, P N Barry MD), (N Carleton, Prof S Oesterreich, P F McAuliffe, Prof A V Lee); (A Nasrazadani MD, K Gade MD, Prof A M Brufksy MD, G J van Londen MD), (Prof R Bhargava MD), (D L Thull MS, P L Mai MD), (E J Diego MD, Prof M T Lotze MD, P F McAuliffe), (Prof M T Lotze), (Prof M T Lotze), (Prof S Oesterreich, Prof A V Lee), (Prof W A Berg MD, Prof M L Zuley MD); (O C Marroquin MD)
| | - G J van Londen
- (N Carleton BS, Prof S Oesterreich PhD, P F McAuliffe MD, Prof A V Lee PhD) (S Beriwal MD, P N Barry MD), (N Carleton, Prof S Oesterreich, P F McAuliffe, Prof A V Lee); (A Nasrazadani MD, K Gade MD, Prof A M Brufksy MD, G J van Londen MD), (Prof R Bhargava MD), (D L Thull MS, P L Mai MD), (E J Diego MD, Prof M T Lotze MD, P F McAuliffe), (Prof M T Lotze), (Prof M T Lotze), (Prof S Oesterreich, Prof A V Lee), (Prof W A Berg MD, Prof M L Zuley MD); (O C Marroquin MD)
| | - Oscar C Marroquin
- (N Carleton BS, Prof S Oesterreich PhD, P F McAuliffe MD, Prof A V Lee PhD) (S Beriwal MD, P N Barry MD), (N Carleton, Prof S Oesterreich, P F McAuliffe, Prof A V Lee); (A Nasrazadani MD, K Gade MD, Prof A M Brufksy MD, G J van Londen MD), (Prof R Bhargava MD), (D L Thull MS, P L Mai MD), (E J Diego MD, Prof M T Lotze MD, P F McAuliffe), (Prof M T Lotze), (Prof M T Lotze), (Prof S Oesterreich, Prof A V Lee), (Prof W A Berg MD, Prof M L Zuley MD); (O C Marroquin MD)
| | - Darcy L Thull
- (N Carleton BS, Prof S Oesterreich PhD, P F McAuliffe MD, Prof A V Lee PhD) (S Beriwal MD, P N Barry MD), (N Carleton, Prof S Oesterreich, P F McAuliffe, Prof A V Lee); (A Nasrazadani MD, K Gade MD, Prof A M Brufksy MD, G J van Londen MD), (Prof R Bhargava MD), (D L Thull MS, P L Mai MD), (E J Diego MD, Prof M T Lotze MD, P F McAuliffe), (Prof M T Lotze), (Prof M T Lotze), (Prof S Oesterreich, Prof A V Lee), (Prof W A Berg MD, Prof M L Zuley MD); (O C Marroquin MD)
| | - Phuong L Mai
- (N Carleton BS, Prof S Oesterreich PhD, P F McAuliffe MD, Prof A V Lee PhD) (S Beriwal MD, P N Barry MD), (N Carleton, Prof S Oesterreich, P F McAuliffe, Prof A V Lee); (A Nasrazadani MD, K Gade MD, Prof A M Brufksy MD, G J van Londen MD), (Prof R Bhargava MD), (D L Thull MS, P L Mai MD), (E J Diego MD, Prof M T Lotze MD, P F McAuliffe), (Prof M T Lotze), (Prof M T Lotze), (Prof S Oesterreich, Prof A V Lee), (Prof W A Berg MD, Prof M L Zuley MD); (O C Marroquin MD)
| | - Emilia J Diego
- (N Carleton BS, Prof S Oesterreich PhD, P F McAuliffe MD, Prof A V Lee PhD) (S Beriwal MD, P N Barry MD), (N Carleton, Prof S Oesterreich, P F McAuliffe, Prof A V Lee); (A Nasrazadani MD, K Gade MD, Prof A M Brufksy MD, G J van Londen MD), (Prof R Bhargava MD), (D L Thull MS, P L Mai MD), (E J Diego MD, Prof M T Lotze MD, P F McAuliffe), (Prof M T Lotze), (Prof M T Lotze), (Prof S Oesterreich, Prof A V Lee), (Prof W A Berg MD, Prof M L Zuley MD); (O C Marroquin MD)
| | - Michael T Lotze
- (N Carleton BS, Prof S Oesterreich PhD, P F McAuliffe MD, Prof A V Lee PhD) (S Beriwal MD, P N Barry MD), (N Carleton, Prof S Oesterreich, P F McAuliffe, Prof A V Lee); (A Nasrazadani MD, K Gade MD, Prof A M Brufksy MD, G J van Londen MD), (Prof R Bhargava MD), (D L Thull MS, P L Mai MD), (E J Diego MD, Prof M T Lotze MD, P F McAuliffe), (Prof M T Lotze), (Prof M T Lotze), (Prof S Oesterreich, Prof A V Lee), (Prof W A Berg MD, Prof M L Zuley MD); (O C Marroquin MD)
| | - Steffi Oesterreich
- (N Carleton BS, Prof S Oesterreich PhD, P F McAuliffe MD, Prof A V Lee PhD) (S Beriwal MD, P N Barry MD), (N Carleton, Prof S Oesterreich, P F McAuliffe, Prof A V Lee); (A Nasrazadani MD, K Gade MD, Prof A M Brufksy MD, G J van Londen MD), (Prof R Bhargava MD), (D L Thull MS, P L Mai MD), (E J Diego MD, Prof M T Lotze MD, P F McAuliffe), (Prof M T Lotze), (Prof M T Lotze), (Prof S Oesterreich, Prof A V Lee), (Prof W A Berg MD, Prof M L Zuley MD); (O C Marroquin MD)
| | - Priscilla F McAuliffe
- (N Carleton BS, Prof S Oesterreich PhD, P F McAuliffe MD, Prof A V Lee PhD) (S Beriwal MD, P N Barry MD), (N Carleton, Prof S Oesterreich, P F McAuliffe, Prof A V Lee); (A Nasrazadani MD, K Gade MD, Prof A M Brufksy MD, G J van Londen MD), (Prof R Bhargava MD), (D L Thull MS, P L Mai MD), (E J Diego MD, Prof M T Lotze MD, P F McAuliffe), (Prof M T Lotze), (Prof M T Lotze), (Prof S Oesterreich, Prof A V Lee), (Prof W A Berg MD, Prof M L Zuley MD); (O C Marroquin MD)
| | - Adrian V Lee
- (N Carleton BS, Prof S Oesterreich PhD, P F McAuliffe MD, Prof A V Lee PhD) (S Beriwal MD, P N Barry MD), (N Carleton, Prof S Oesterreich, P F McAuliffe, Prof A V Lee); (A Nasrazadani MD, K Gade MD, Prof A M Brufksy MD, G J van Londen MD), (Prof R Bhargava MD), (D L Thull MS, P L Mai MD), (E J Diego MD, Prof M T Lotze MD, P F McAuliffe), (Prof M T Lotze), (Prof M T Lotze), (Prof S Oesterreich, Prof A V Lee), (Prof W A Berg MD, Prof M L Zuley MD); (O C Marroquin MD)
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5
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Carleton N, Zou J, Fang Y, Koscumb SE, Shah OS, Chen F, Beriwal S, Diego EJ, Brufsky AM, Oesterreich S, Shapiro SD, Ferris R, Emens LA, Tseng G, Marroquin OC, Lee AV, McAuliffe PF. Outcomes After Sentinel Lymph Node Biopsy and Radiotherapy in Older Women With Early-Stage, Estrogen Receptor-Positive Breast Cancer. JAMA Netw Open 2021; 4:e216322. [PMID: 33856473 PMCID: PMC8050744 DOI: 10.1001/jamanetworkopen.2021.6322] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
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 node-negative 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 SLNB and either LRFS (HR, 1.26; 95% CI, 0.37-4.30; P = .71) or DFS (HR, 1.92; 95% CI, 0.86-4.32; P = .11). In addition, RT was not associated with LRFS (HR, 0.33; 95% CI, 0.09-1.24; P = .10) or DFS (HR, 0.99; 95% CI, 0.46-2.10; P = .97). Subgroup analysis showed that stratification by tumor grade or comorbidity was not associated with LRFS or DFS. Low absolute rates of recurrence were observed when comparing the groups that received SLNB (3.5%) and those that did not (4.5%) as well as the groups that received RT (2.7%) and those that did not (5.5%). CONCLUSIONS AND RELEVANCE This study found that receipt of SLNB or RT was not associated with improved LRFS or DFS in older patients with ER-positive, clinically node-negative breast cancer. Despite limited follow-up time and wide 95% CIs, this study supports the continued deimplementation of both SLNB and RT in accordance with the Choosing Wisely and National Comprehensive Cancer Network guidelines.
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Affiliation(s)
- Neil Carleton
- Women’s Cancer Research Center, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
- Magee-Womens Research Institute, Pittsburgh, Pennsylvania
- Medical Scientist Training Program, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jian Zou
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Yusi Fang
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Stephen E. Koscumb
- Clinical Analytics, UPMC Health Services Division, Pittsburgh, Pennsylvania
| | - Osama Shiraz Shah
- Women’s Cancer Research Center, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Fangyuan Chen
- Women’s Cancer Research Center, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
- School of Medicine, Tsinghua University, Beijing, China
| | - Sushil Beriwal
- Magee-Womens Research Institute, Pittsburgh, Pennsylvania
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Emilia J. Diego
- Division of Surgical Oncology, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Adam M. Brufsky
- Women’s Cancer Research Center, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
- Magee-Womens Research Institute, Pittsburgh, Pennsylvania
- Division of Medical Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Steffi Oesterreich
- Women’s Cancer Research Center, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
- Magee-Womens Research Institute, Pittsburgh, Pennsylvania
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Steven D. Shapiro
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Robert Ferris
- Magee-Womens Research Institute, Pittsburgh, Pennsylvania
| | - Leisha A. Emens
- Women’s Cancer Research Center, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
- Magee-Womens Research Institute, Pittsburgh, Pennsylvania
- Division of Medical Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - George Tseng
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Oscar C. Marroquin
- Clinical Analytics, UPMC Health Services Division, Pittsburgh, Pennsylvania
| | - Adrian V. Lee
- Women’s Cancer Research Center, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
- Magee-Womens Research Institute, Pittsburgh, Pennsylvania
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Priscilla F. McAuliffe
- Women’s Cancer Research Center, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
- Magee-Womens Research Institute, Pittsburgh, Pennsylvania
- Division of Surgical Oncology, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Wei M, Wang X, Zimmerman DN, Burt LM, Haaland B, Henry NL. Endocrine therapy and radiotherapy use among older women with hormone receptor-positive, clinically node-negative breast cancer. Breast Cancer Res Treat 2021; 187:287-294. [PMID: 33420863 DOI: 10.1007/s10549-020-06071-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/23/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To examine patterns of radiotherapy (RT) and endocrine therapy (ET) use, associations between RT omission and ET adherence, and associations among ET and RT use and disease recurrence in older women with early-stage, estrogen receptor-positive breast cancer. METHODS Women age 65 and older diagnosed with hormone receptor-positive, clinically node-negative breast cancer between 2005 and 2018 and who did not undergo mastectomy were included. Multinomial logistic regression was used to examine the trends in practice patterns over time and by age. Kaplan-Meier estimates were used to estimate the probability of ET discontinuation. Cox proportional hazards models were constructed to assess associations between recurrence and ET/RT. RESULTS Of the 484 enrolled patients, 47.9% patients underwent RT and initiated ET, 27.4% received ET alone, 10.2% received RT alone, and 13.8% patients received neither. Older patients had a higher probability of receiving ET alone or neither ET nor RT (both p < 0.001). The probability of initiating ET was greater among patients who underwent RT than those who omitted RT (p < 0.001). Regardless of RT status (RT or no RT), initiation and continuation of ET may be associated with reduced risk of recurrence. CONCLUSION Patients who opt for no adjuvant therapy, or who do not tolerate ET, are at increased risk of disease recurrence if they omit RT. Clinicians should consider the likelihood a patient will adhere to ET prior to recommending omission of RT.
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Affiliation(s)
- Mei Wei
- Division of Oncology, Department of Internal Medicine, University of Utah, 2000 Circle of Hope Dr., Salt Lake City, UT, 84112, USA.,Huntsman Cancer Institute, 2000 Circle of Hope Dr., Salt Lake City, UT, 84112, USA
| | - Xuechen Wang
- Population Health Science, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Danielle N Zimmerman
- Division of Physical Medicine and Rehabilitation, University of Utah School of Medicine, 85 North Medical Drive, Salt Lake City, UT, 84132, USA
| | - Lindsay M Burt
- Huntsman Cancer Institute, 2000 Circle of Hope Dr., Salt Lake City, UT, 84112, USA.,Department of Radiation Oncology, University of Utah, 2000 Circle of Hope Dr., Salt Lake City, UT, 84112, USA
| | - Benjamin Haaland
- Huntsman Cancer Institute, 2000 Circle of Hope Dr., Salt Lake City, UT, 84112, USA.,Population Health Science, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - N Lynn Henry
- Division of Oncology, Department of Internal Medicine, University of Utah, 2000 Circle of Hope Dr., Salt Lake City, UT, 84112, USA. .,Huntsman Cancer Institute, 2000 Circle of Hope Dr., Salt Lake City, UT, 84112, USA. .,Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, 500 S. State Street, Ann Arbor, MI, 48109, USA. .,Rogel Cancer Center, 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA.
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7
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Joseph K, Zebak S, Alba V, Mah K, Au C, Vos L, Ghosh S, Abraham A, Chafe S, Wiebe E, Liu HW, Chambers C, Gabos Z, Tankel K, Lupichuk S, King K. Adjuvant breast radiotherapy, endocrine therapy, or both after breast conserving surgery in older women with low-risk breast cancer: Results from a population-based study. Radiother Oncol 2020; 154:93-100. [PMID: 32941956 DOI: 10.1016/j.radonc.2020.09.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/02/2020] [Accepted: 09/09/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE The relative benefit of adjuvant radiotherapy (RT) alone in older women with low-risk early breast cancer (EBC) remains unclear. It is hypothesized that adjuvant RT-alone can improve outcomes of older patients with low-risk EBC, similar to endocrine therapy (ET) alone or combination of RT + ET. METHODS In this population based study, we identified all women aged ≥70 with T1-2, N0, ER+ve, Her-2/neu-ve EBC treated with breast conserving surgery (BCS), followed by adjuvant treatments (RT-alone, ET-alone, or RT + ET combination) from 2005 to 2015. Primary outcome measures were recurrence-free survival (RFS), overall survival (OS), and breast cancer specific survival (BCSS). Treatment details were collected and Charlson Comorbidity Index (CCI) was calculated. RESULTS A total of 1166 patients were identified. Median follow-up was 76.5 months. Adjuvant treatments: BCS only 130 (11%), RT 378 (32.5%), ET 161 (14%), and RT + ET 497 (42.5%). Less than 60% of women completed 5-years of ET. Compared to BCS alone, RT resulted in significant improvement in RFS (HR = 0.174; p < 0.001), similar to ET (HR = 0.414; p = 0.007) and RT + ET (HR = 0.236; p < 0.001). Determinants of OS were age, tumor grade, comorbidities, and adjuvant therapy. Increased comorbidity scores (0 vs. 1; 0 vs. ≥2) were associated with reduced OS (HR = 1.40; p = 0.013 and HR = 1.98; p < 0.001), without impact on RFS or BCSS. CONCLUSIONS Adjuvant RT-alone is a reasonable alternative to ET or RT + ET for older women with biologically favorable EBC. No difference in RFS or BCSS was noted between RT, ET, and RT + ET. Comorbidity was independently associated with reduced overall survival.
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Affiliation(s)
- Kurian Joseph
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Canada.
| | | | | | - Kayla Mah
- University of Alberta, Edmonton, Canada
| | - Cara Au
- University of Alberta, Edmonton, Canada
| | - Larissa Vos
- Alberta Cancer Clinical Trials, Cross Cancer Institute, Edmonton, Canada
| | - Sunita Ghosh
- Division of Medical Oncology, Department of Oncology, University of Alberta, & Cross Cancer Institute, Edmonton, Canada
| | - Aswin Abraham
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Canada
| | - Susan Chafe
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Canada
| | - Ericka Wiebe
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Canada
| | | | | | - Zsolt Gabos
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Canada
| | - Keith Tankel
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Canada
| | - Sasha Lupichuk
- Division of Medical Oncology, University of Calgary & Tom Baker Cancer Center, Canada
| | - Karen King
- Division of Medical Oncology, Department of Oncology, University of Alberta, & Cross Cancer Institute, Edmonton, Canada
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