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Allali S, Carton M, Everhard S, Rivera S, Ghannam Y, Peignaux K, Guilbert P, De La Lande B, Chara-Brunaud C, Blanchecotte J, Pasquier D, Racadot S, Bourgier C, Cottu P, André F, Kirova Y. CANTO skin: Evaluation of skin toxicity risk factors in patients treated for breast cancer. Int J Cancer 2023; 153:1797-1808. [PMID: 37572223 DOI: 10.1002/ijc.34664] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 06/21/2023] [Indexed: 08/14/2023]
Abstract
Skin reaction is a common toxicity during oncology management, especially followed during the radiotherapy. Its assessment and understanding of the factors influencing its occurrence, is a major issue in the management of patients treated for an early breast cancer (BC). We evaluated 8561 patients during their overall management for a BC. We focus on specific skin toxicities: erythema, fibrosis, telangiectasia and changes of skin colour. These toxicities were assessed at the baseline defined as 0-3-6 (M0), 12 (M12), 36 (M36) and 60 (M60) months. The prevalence of toxicities of interest varied over time, so at M0, 30.4% of patients had erythema while 17.7% of patients had fibrosis. At M60, the prevalence of erythema was 2%, while fibrosis remained stable at about 19%. After adjustments, at M0, there was a significant association between the onset of cutaneous erythema and obesity, the presence of axillary dissection, the type of surgery and the tumour phenotype RH+/HER2+. Concerning fibrosis, a significant association was found, at M12, with the age of the patient, obesity, Charlson score and type of surgery. Concerning the modification of skin colour at M12, we find a link between the age of the patient, obesity, tobacco consumption and alcohol consumption. The prevention of this toxicity is a major issue for the quality of life. Our results allow us to understand the risk of developing skin toxicity in a patient, depending on her intrinsic, tumour or therapeutic characteristics and to implement adapted means of prevention and monitoring.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - David Pasquier
- Centre Oscar Lambret, Academic Department of Radiation Oncology, Lille, France
- Université de Lille, CHU Lille, CNRS, Centrale Lille, Lille, France
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2
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Miller K, Gannon MR, Medina J, Clements K, Dodwell D, Horgan K, Park MH, Cromwell DA. The Association Between Survival and Receipt of Post-mastectomy Radiotherapy According to Age at Diagnosis Among Women With Early Invasive Breast Cancer: A Population-Based Cohort Study. Clin Oncol (R Coll Radiol) 2023; 35:e265-e277. [PMID: 36764877 DOI: 10.1016/j.clon.2023.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 11/08/2022] [Accepted: 01/16/2023] [Indexed: 01/25/2023]
Abstract
AIMS Clinical trials of post-mastectomy radiotherapy (PMRT) for early invasive breast cancer (EIBC) have included few older women. This study examined whether the association between overall survival or breast cancer-specific survival (BCSS) and receipt of PMRT for EIBC altered with age. MATERIALS AND METHODS The study used patient-level linked cancer registration, routine hospital and radiotherapy data for England and Wales. It included 31 243 women aged ≥50 years diagnosed between 2014 and 2018 with low- (T1-2N0), intermediate- (T3N0/T1-2N1) or high-risk (T1-2N2/T3N1-2) EIBC who received a mastectomy within 12 months from diagnosis. Patterns of survival were analysed using a landmark approach. Associations between overall survival/BCSS and PMRT in each risk group were analysed with flexible parametric survival models, which included patient and tumour factors; whether the association between PMRT and overall survival/BCSS varied by age was assessed using interaction terms. RESULTS Among 4711 women with high-risk EIBC, 86% had PMRT. Five-year overall survival was 70.5% and BCSS was 79.3%. Receipt of PMRT was associated with improved overall survival [adjusted hazard ratio (aHR) 0.75, 95% confidence interval 0.64-0.87] and BCSS (aHR 0.78, 95% confidence interval 0.65-0.95) compared with women who did not have PMRT; associations did not vary by age (overall survival, P-value for interaction term = 0.141; BCSS, P = 0.077). Among 10 814 women with intermediate-risk EIBC, 59% had PMRT; 5-year overall survival was 78.4% and BCSS was 88.0%. No association was found between overall survival (aHR 1.01, 95% confidence interval 0.92-1.11) or BCSS (aHR 1.16, 95% confidence interval 1.01-1.32) and PMRT. There was statistical evidence of a small change in the association with age for overall survival (P = 0.007), although differences in relative survival were minimal, but not for BCSS (P = 0.362). CONCLUSIONS The association between PMRT and overall survival/BCSS does not appear to be modified by age among women with high- or intermediate-risk EIBC and, thus, treatment recommendations should not be modified on the basis of age alone.
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Affiliation(s)
- K Miller
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
| | - M R Gannon
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - J Medina
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - K Clements
- National Cancer Registration and Analysis Service, NHS Digital, Birmingham, UK
| | - D Dodwell
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - K Horgan
- Department of Breast Surgery, St James's University Hospital, Leeds, UK
| | - M H Park
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - D A Cromwell
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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3
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Quality Indicators Compliance and Survival Outcomes in Breast Cancer according to Age in a Certified Center. Cancers (Basel) 2023; 15:cancers15051446. [PMID: 36900236 PMCID: PMC10000816 DOI: 10.3390/cancers15051446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/19/2023] [Accepted: 02/23/2023] [Indexed: 03/02/2023] Open
Abstract
Age as a breast cancer (BC) prognostic factor remains debatable. Several studies have investigated clinicopathological features at different ages, but few make an age group direct comparison. The European Society of Breast Cancer Specialists quality indicators (EUSOMA-QIs) allow a standardized quality assurance of BC diagnosis, treatment, and follow-up. Our objective was to compare clinicopathological features, compliance to EUSOMA-QIs and BC outcomes in three age groups (≤45 years, 46-69 years, and ≥70 years). Data from 1580 patients with staged 0-IV BC from 2015 to 2019 were analyzed. The minimum standard and desirable target on 19 mandatory and 7 recommended QIs were studied. The 5-year relapse rate, overall survival (OS), and BC-specific survival (BCSS) were also evaluated. No meaningful differences in TNM staging and molecular subtyping classification between age groups were found. On the contrary, disparities in QIs compliance were observed: 73.1% in ≤45 years and 46-69 years women vs. 54% in older patients. No differences in loco-regional or distant progression were observed between age groups. Nevertheless, lower OS was found in older patients due to concurrent non-oncological causes. After survival curves adjustment, we underscored evidence of undertreatment impacting BCSS in ≥70 years women. Despite a unique exception-more invasive G3 tumors in younger patients-no age-specific differences in BC biology impacting outcome were found. Although increased noncompliance in older women, no outcome correlation was observed with QIs noncompliance in any age group. Clinicopathological features and differences in multimodal treatment (not the chronological age) are predictors of lower BCSS.
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4
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Chen CC, Ho WL, Lin CH, Chen HH. Stratified analysis of the association between periodontitis and female breast cancer based on age, comorbidities and level of urbanization: A population-based nested case-control study. PLoS One 2022; 17:e0271948. [PMID: 35881627 PMCID: PMC9321417 DOI: 10.1371/journal.pone.0271948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 07/11/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose
To conduct stratified analysis of the association between periodontitis exposure and the risk of female breast cancer based on age, comorbidities and level of urbanization.
Methods
Using claims data taken from the 1997–2013 Taiwanese National Health Insurance Research Database (NHIRD), we identified 60,756 newly-diagnosed female breast cancer patients during the period 2003–2013 from all beneficiaries. We then randomly selected 243,024 women without breast cancer matching (1:4) for age and the year of the index date during 1997–2013 from a one million representative population acting as the control group. A conditional logistic regression analysis was used to examine the association between periodontitis (ICD-9-CM codes 523.3–4) and the risk of breast cancer, shown as an odds ratio (OR) with a 95% confidence interval (CI) after adjustments for the Charlson Comorbidity Index (CCI) and level of urbanization. Subgroup analyses were conducted based on age, CCI and level of urbanization.
Results
The mean ± standard deviation age was 53 ± 14 years. After adjusting for potential confounders, the risk of female breast cancer was found to be associated with a history of periodontitis (OR, 1.12; 95% CI, 1.10–1.14). Such an association was significantly different between patients aged < 65 years (OR, 1.09; 95% CI, 1.06–1.11) and patients aged ≥ 65 years (OR, 1.23; 95% CI, 1.18–1.28; p for interaction <0.001), as well as between patients where the CCI = 0 (OR, 1.17; 95% CI, 1.15–1.20) and patients with CCI > 0 (OR, 0.99; 95% CI, 0.96–1.03; p for interaction <0.001). The highest level of urbanization was also associated with the risk of breast cancer.
Conclusions
This population-based nested case-control study demonstrated that periodontitis was significantly associated with the risk of female breast cancer and such an association was modified by both age and comorbidities.
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Affiliation(s)
- Chien-Chih Chen
- Program in Translational Medicine, National Chung-Hsing University, Taichung, Taiwan
- Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wei-Li Ho
- Division of Allergy, Immunology and Rheumatology, Chiayi Branch, Taichung Veterans General Hospital Taichung, Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hsin-Hua Chen
- Program in Translational Medicine, National Chung-Hsing University, Taichung, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine, Chung-Hsing University, Taichung, Taiwan
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan
- Division of General Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- * E-mail:
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Mackenzie P, Vajdic C, Delaney G, Comans T, Agar M, Gabriel G, Barton M. Development of an age- and comorbidity adjusted- optimal radiotherapy utilisation rate for women with breast cancer. J Geriatr Oncol 2022; 13:844-849. [PMID: 35514015 DOI: 10.1016/j.jgo.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/07/2022] [Accepted: 04/06/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Optimal radiotherapy utilisation (RTU) modelling estimates the proportion of people with cancer who would benefit from radiotherapy. Older adults with cancer may have comorbidities that can impact physiological reserve and affect radiotherapy recommendations. These have not been considered in previous models. We aimed to develop an age- and comorbidity-adjusted optimal RTU model for breast cancer. METHODS New South Wales (NSW) Cancer Registry data (2010-2014) linked to radiotherapy data (2010-2015) and hospitalisation data (2008-2015) was used to determine the number of women diagnosed with invasive breast cancer in four pre-specified age groups. The Charlson Comorbidity Index (CCI), Cancer-Specific C3 'all sites' index and the Hospital Frailty Risk Score (HFRS) were derived for each woman from diagnostic codes in hospital records. Women were deemed unfit, and thus unsuitable candidates for radiotherapy, if the comorbidity indices were as follows: CCI ≥2; C3 score ≥ 3; and HFRS ≥5. The proportions of women suitable for radiotherapy in each age group were then incorporated into a breast cancer decision tree model. The actual RTU was also calculated using the linked datasets. RESULTS 23,601 women were diagnosed with breast cancer in NSW from 2010 to 2014 and 2526 were aged 80+ years. The overall comorbidity adjusted- RTU for women of all ages was 85·9% (CCI), 83·7% (C3) and 81·9% (HFRS). The optimal comorbidity adjusted- RTU for women aged 80+ was 76·1% (CCI), 70·1% (C3) and 61·8% (HFRS). The actual RTU for women aged 80+ years was 24.7%. CONCLUSION The vast majority of older Australian women with breast cancer are fit for radiotherapy. The overall optimal RTU is only slightly reduced when adjusted for age and comorbidities and was similar using each of the three indices examined. Our data suggest radiotherapy is markedly underutilised for older women with breast cancer.
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Affiliation(s)
- Penny Mackenzie
- Icon Cancer Centre, St Andrew's Hospital, Toowoomba, Queensland, Australia; The University of New South Wales, Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, Liverpool, Sydney, Australia.
| | - Claire Vajdic
- Cancer Epidemiology Research Unit, Centre for BIG Data Research in Health, The University of New South Wales, Sydney, Australia
| | - Geoff Delaney
- The University of New South Wales, Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, Liverpool, Sydney, Australia; Liverpool Hospital, Sydney, Australia
| | - Tracy Comans
- Centre for Health Services Research, The University of Queensland, Australia
| | - Meera Agar
- Centre for Improving Palliative, Aged and Chronic Care through Clinical Research and Translation, The University of Technology, Sydney, Australia; Liverpool Hospital, Sydney, Australia
| | - Gabriel Gabriel
- The University of New South Wales, Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, Liverpool, Sydney, Australia
| | - Michael Barton
- The University of New South Wales, Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, Liverpool, Sydney, Australia; Liverpool Hospital, Sydney, Australia
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Sun J, Lee MC. Response to Letter to the Editor: "Omitting Sentinel Lymph Node Biopsy in Elderly Patients: A Lost Opportunity?" by Todd Tuttle et al. Ann Surg Oncol 2021; 28:5444-5445. [PMID: 33604828 DOI: 10.1245/s10434-021-09728-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 11/18/2022]
Affiliation(s)
- James Sun
- Department of General Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - M Catherine Lee
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
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7
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Takaki J, Hosoda Y, Okamoto K, Fukui T. Radiotherapy-related skin ulcer communicating with a left ventricular aneurysm. Interact Cardiovasc Thorac Surg 2020; 30:783-784. [PMID: 32048710 DOI: 10.1093/icvts/ivaa014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/15/2019] [Accepted: 01/06/2020] [Indexed: 11/13/2022] Open
Abstract
Although radiation therapy is widely used to treat breast cancer, high doses of radiation may cause various complications. We report a case of a left ventricular aneurysm complicated with an intractable skin ulcer caused by radiation therapy for breast cancer. The communication between the aneurysm and skin ulcer caused severe bleeding. An urgent left ventricular repair and chest wall reconstruction with a rectus abdominis flap were performed successfully.
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Affiliation(s)
- Jun Takaki
- Department of Cardiovascular Surgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Yasuhito Hosoda
- Department of Cardiovascular Surgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Ken Okamoto
- Department of Cardiovascular Surgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Toshihiro Fukui
- Department of Cardiovascular Surgery, Kumamoto University Hospital, Kumamoto, Japan
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8
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McWilliams L. An Overview of Treating People with Comorbid Dementia: Implications for Cancer Care. Clin Oncol (R Coll Radiol) 2020; 32:562-568. [PMID: 32718761 DOI: 10.1016/j.clon.2020.06.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/02/2020] [Accepted: 06/18/2020] [Indexed: 01/26/2023]
Abstract
With increasing prevalence of both cancer and dementia in the UK, due to an ageing population, oncology healthcare professionals will experience higher numbers of people with both conditions. As dementia is highly heterogeneous and symptoms vary from individual to individual, it presents specific challenges for healthcare professionals, people with dementia and caregivers alike. This overview will describe current theories that explain the association between cancer and dementia, report prevalence rates and highlight the evidence on the impact of having a diagnosis of dementia on outcomes along the cancer pathway from cancer symptom detection to cancer treatment outcomes. It suggests that although prevalence rates of cancer and dementia are typically lower than other comorbidities, people with cancer and dementia have poorer cancer-related outcomes. This includes later stage cancer diagnoses, fewer cancer treatment options and an increased risk of death compared with people who have cancer alone or other comorbid conditions. Considerations for cancer treatment decision making and management are proposed to improve patient experience for this group.
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Affiliation(s)
- L McWilliams
- Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK.
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9
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Wong G, Lam E, Karam I, Yee C, Drost L, Tam S, Lam H, McCarvell A, McKenzie E, Chow E. The impact of smoking on adjuvant breast cancer radiation treatment: A systematic review. Cancer Treat Res Commun 2020; 24:100185. [PMID: 32593846 DOI: 10.1016/j.ctarc.2020.100185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND The influence of cigarette smoking on cancer risk has been well-studied. Similarly, exposure to ionizing radiation from radiotherapy (RT) can produce detrimental effects on an individual's health. In patients administered RT, there has been an observed relationship in other primary carcinomas. The purpose of this systematic review was to summarize the influence of cigarette smoking on outcomes post adjuvant RT in breast cancer patients. METHODS OVID Medline, Cochrane and Embase were searched and 1893 articles were identified. A total of 71 articles were included in the review. Study type, published year and sample size, age, systemic therapies, RT techniques and treatment side effects were collected if available. RESULTS The review found 198 different outcomes which fell into 7 categories and similar outcomes were recorded. 40% of skin reaction outcomes, 50% of cardiovascular outcomes, 71% of reconstruction outcomes, 29% of pulmonary function outcomes, 33% of mortality outcomes and 42% of secondary recurrence outcomes reported significant differences between smokers and non-smokers. None of the articles reported non-smokers to have a higher risk than smokers. CONCLUSION Cigarette smoking can pose a higher risk of post-treatment complications that can influence an individual's quality of life, survival rate and/or recurrence risk. This review further assessed the impact of smoking on various patient outcomes and side-effects in the adjuvant breast RT setting. The information provided in this review suggest that smoking cessation programs would help educate patients to understand their risks of being a current or former smoker when undergoing RT.
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Affiliation(s)
- Gina Wong
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Emily Lam
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Irene Karam
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Caitlin Yee
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Leah Drost
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Samantha Tam
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Henry Lam
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Alyson McCarvell
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Erin McKenzie
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Edward Chow
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
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10
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Older age and comorbidity in breast cancer: is RT alone the new therapeutic frontier? J Cancer Res Clin Oncol 2020; 146:1791-1800. [PMID: 32405744 DOI: 10.1007/s00432-020-03243-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 05/01/2020] [Indexed: 10/24/2022]
Abstract
AIM To assess the impact of age, comorbidities and endocrine therapy (ET) in older breast cancer (BC) patients treated with hypofractionated radiotherapy (Hypo-RT). METHODS From June 2009 to December 2017, we enrolled in this study 735 ER-positive BC patients (stage pT1-T2, pNx-1, M0 and age ≥ 65 years) receiving hypo-RT and followed them until September 2019. Baseline comorbidities included in the hypertension-augmented Charlson Comorbidity Index were retrospectively retrieved. Logistic regression model estimated adjusted-odds ratios (ORs) of ET prescription in relation to baseline patient and tumor characteristics. Competing risk analysis estimated 5-year cumulative incidence function (CIF) of ET discontinuation due to side effects (with BC progression or death as competing events), and its effect on locoregional recurrence (LRR) and distant metastasis (DM) (with death as competing event). RESULTS ET has been prescribed in 89% patients. In multivariable analysis, the odds of ET prescription was significantly reduced in older patients (≥ 80 years, OR 0.08, 95% CI 0.03-0.20) and significantly increased in patients with moderate comorbidity. Patients ≥ 80 years discontinued the prescribed therapy earlier and more frequently than younger (65-69 years) patients (p = 0.060). Five-year CIF of LLR, DM and death from causes other that BC were 1.7%, 2.2% and 7.5%, respectively. Patients who discontinued ET had higher chance of LRR (p = 0.004). ET use did not impact on OS in any of the analyzed groups. CONCLUSIONS In older patients, ET did not show a benefit in terms of overall survival. Further studies focusing on tailored treatment approaches are warranted to offer the best care in terms of adjuvant treatment to these patients.
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11
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Cao KI, Waechter L, Carton M, Kirova YM. Outcomes of exclusive radiation therapy for older women with breast cancer according to age and comorbidity status: An observational retrospective study. Breast J 2020; 26:976-980. [PMID: 32057177 DOI: 10.1111/tbj.13764] [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: 09/19/2019] [Revised: 12/25/2019] [Accepted: 01/10/2020] [Indexed: 11/30/2022]
Abstract
The management of older patients with breast cancer, a public health issue, remains a highly topical subject. Among this heterogeneous population, only few studies have focused on outcomes of older women treated with exclusive radiation therapy for localized BC. This retrospective study provides data concerning the efficacy and safety of exclusive RT, as well as the impact of comorbidities according to the Charlson Comorbidity Index on survival in this subset of women not suitable for surgery or who have refused it. This analysis demonstrates that this treatment is well-tolerated; however, the prognosis is strongly impacted by age and comorbidities.
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Affiliation(s)
- Kim I Cao
- Department of Radiation Oncology, Institut Curie, Paris, France
| | | | - Matthieu Carton
- Department of Biostatistics, Institut Curie, Saint-Cloud, France
| | - Youlia M Kirova
- Department of Radiation Oncology, Institut Curie, Paris, France
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12
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La Rocca E, Meneghini E, Dispinzieri M, Fiorentino A, Bonfantini F, Di Cosimo S, Gennaro M, Cosentino V, Sant M, Pignoli E, Valdagni R, Lozza L, De Santis MC. Hypofractionated irradiation in 794 elderly breast cancer patients: An observational study. Breast J 2019; 26:188-196. [DOI: 10.1111/tbj.13489] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 06/26/2019] [Accepted: 07/01/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Eliana La Rocca
- Radiotherapy Unit 1 Fondazione IRCCS Istituto Nazionale dei Tumore Milan Italy
- Department of Oncology and Hemato‐oncology Università degli Studi di Milano Milan Italy
| | - Elisabetta Meneghini
- Analytical Epidemiology and Health Impact Unit Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy
| | - Michela Dispinzieri
- Radiotherapy Unit 1 Fondazione IRCCS Istituto Nazionale dei Tumore Milan Italy
| | - Alba Fiorentino
- Radiation Oncology General Regional Hospital “F. Miulli” Acqua viva delle Fonti Italy
| | | | - Serena Di Cosimo
- Department of Applied Research and Technological Development (DRAST) Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy
| | | | - Vito Cosentino
- Medical Physics Unit Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy
| | - Milena Sant
- Analytical Epidemiology and Health Impact Unit Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy
| | - Emanuele Pignoli
- Medical Physics Unit Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy
| | - Riccardo Valdagni
- Department of Oncology and Hemato‐oncology Università degli Studi di Milano Milan Italy
- Radiation Oncology 1 and Prostate Cancer Program Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy
| | - Laura Lozza
- Radiotherapy Unit 1 Fondazione IRCCS Istituto Nazionale dei Tumore Milan Italy
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13
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Downs-Canner S, Zabor EC, Wind T, Cobovic A, McCormick B, Morrow M, Heerdt A. Radiation Therapy After Breast-Conserving Surgery in Women 70 Years of Age and Older: How Wisely Do We Choose? Ann Surg Oncol 2019; 26:969-975. [PMID: 30737670 DOI: 10.1245/s10434-018-07151-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Indexed: 12/23/2022]
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.
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Affiliation(s)
- Stephanie Downs-Canner
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emily C Zabor
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tyler Wind
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Armend Cobovic
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Beryl McCormick
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alexandra Heerdt
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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