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Breast Cancer Research and Treatment

, Volume 165, Issue 3, pp 669–676 | Cite as

Increasing utilization of regional nodal irradiation in elderly node-positive women and declining emphasis on demographic factors

  • Jason K. Molitoris
  • Tejan Diwanji
  • James W. Snider
  • Emily C. Bellavance
  • Susan B. Kesmodel
  • Paula Rosenblatt
  • Katherine Tkaczuk
  • Soren M. Bentzen
  • Randi J. Cohen
  • Elizabeth M. Nichols
  • Sally B. Cheston
  • Steven J. FeigenbergEmail author
Epidemiology

Abstract

Purpose

To evaluate the practice patterns for the use of regional nodal irradiation (RNI) in treatment of elderly women with low volume node-positive breast cancer in the setting of breast conservation surgery (BCS).

Methods

Women aged 70–89 diagnosed with unilateral, pathologic T1-2N1M0 breast cancer from 2004 to 2013, who underwent BCS and received radiotherapy were identified from the National Cancer Database. In 2011, two major trials were presented that helped define indications for RNI. Patients were dichotomized into “early”, i.e. diagnosed up to 2010, and “late” cohorts. Patient and treatment characteristics were compared between the cohorts and logistic regression used to determine independent factors associated with the receipt of RNI.

Results

7228 women met inclusion criteria; 4330 (59.9%) in early and 2898 (40.1%) in late cohorts. Utilization of RNI increased from 33.9% in early to 42.5% in late cohorts (P ≤ 0.001) and was independent of a general increase in RNI utilization. RNI in the early and late cohorts was not different between the study population and younger women (P > 0.05). RNI utilization increased in both cohorts with increasing number of positive lymph nodes. In the early cohort, RNI was also associated with higher grade, white race and lower income. In the late cohort, RNI increased with the presence of multiple, predefined risk factors.

Conclusions

There was an increase in utilization of RNI for elderly patients from 2004 to 2013. In more recent years, the primary factors associated with receipt of RNI were tumor related with declining importance of demographic factors.

Keywords

Breast cancer Regional nodal irradiation Elderly Radiation 

Notes

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    EBCTCG (Early Breast Cancer Trialists’ Collaborative Group), McGale P, Taylor C et al (2014) Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet 383:2127–2135. doi: 10.1016/S0140-6736(14)60488-8 CrossRefGoogle Scholar
  2. 2.
    Hughes KS, Schnaper LA, Berry D et al (2004) Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer. N Engl J Med 351:971–977. doi: 10.1056/NEJMoa040587 CrossRefPubMedGoogle Scholar
  3. 3.
    Kunkler IH, Williams LJ, Jack WJ et al (2015) Breast-conserving surgery with or without irradiation in women aged 65 years or older with early breast cancer (PRIME II): a randomised controlled trial. Lancet Oncol 16:266–273CrossRefGoogle Scholar
  4. 4.
    Whelan T, Olivotto I, Ackerman I (2011) NCIC-CTG MA. 20: an intergroup trial of regional nodal irradiation in early breast cancer. J Clin Oncol 29:LBA1003Google Scholar
  5. 5.
    Giuliano AE, Hunt KK, Ballman KV et al (2011) Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA 305:569–575. doi: 10.1001/jama.2011.90 CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Donker M, van Tienhoven G, Straver ME et al (2014) Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol 15:1303–1310CrossRefGoogle Scholar
  7. 7.
    Poortmans PM, Collette S, Kirkove C et al (2015) Internal mammary and medial supraclavicular irradiation in breast cancer. N Engl J Med 373:317–327. doi: 10.1056/NEJMoa1415369 CrossRefPubMedGoogle Scholar
  8. 8.
    Whelan TJ, Olivotto IA, Parulekar WR et al (2015) Regional nodal irradiation in early-stage breast cancer. N Engl J Med 373:307–316. doi: 10.1056/NEJMoa1415340 CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Thorsen LB, Offersen BV, Dano H et al (2016) DBCG-IMN: a population-based cohort study on the effect of internal mammary node irradiation in early node-positive breast cancer. J Clin Oncol 34:314–320. doi: 10.1200/JCO.2015.63.6456 CrossRefPubMedGoogle Scholar
  10. 10.
    Belkacemi Y, Kaidar-Person O, Poortmans P et al (2015) Patterns of practice of regional nodal irradiation in breast cancer: results of the European Organization for Research and Treatment of Cancer (EORTC) NOdal Radiotherapy (NORA) survey. Ann Oncol 26:529–535. doi: 10.1093/annonc/mdu561 CrossRefPubMedGoogle Scholar
  11. 11.
    Bilimoria KY, Stewart AK, Winchester DP et al (2008) The National Cancer Data Base: a powerful initiative to improve cancer care in the United States. Ann Surg Oncol 15:683–690CrossRefGoogle Scholar
  12. 12.
    National Cancer Data Base (2012) Scope of regional lymph node surgery: a review of data validity, revised coding directives, and agency transition plans. http://www.facs.org/cancer/ncdb/scope-regional-lymph-node-surgery.pdf
  13. 13.
    Fyles AW, McCready DR, Manchul LA et al (2004) Tamoxifen with or without breast irradiation in women 50 years of age or older with early breast cancer. N Engl J Med 351:963–970. doi: 10.1056/NEJMoa040595 CrossRefPubMedGoogle Scholar
  14. 14.
    Antonini N, Jones H, Horiot JC et al (2007) Effect of age and radiation dose on local control after breast conserving treatment: EORTC trial 22881-10882. Radiother Oncol 82:265–271CrossRefGoogle Scholar
  15. 15.
    Overgaard M, Jensen MB, Overgaard J et al (1999) Postoperative radiotherapy in high-risk postmenopausal breast-cancer patients given adjuvant tamoxifen: Danish Breast Cancer Cooperative Group DBCG 82c randomised trial. Lancet 353:1641–1648CrossRefGoogle Scholar
  16. 16.
    Overgaard M, Hansen PS, Overgaard J et al (1997) Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. Danish Breast Cancer Cooperative Group 82b Trial. N Engl J Med 337:949–955. doi: 10.1056/NEJM199710023371401 CrossRefPubMedGoogle Scholar
  17. 17.
    Jagsi R, Chadha M, Moni J et al (2014) Radiation field design in the ACOSOG Z0011 (Alliance) trial. J Clin Oncol 32:3600–3606. doi: 10.1200/JCO.2014.56.5838 CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Schlembach PJ, Buchholz TA, Ross MI et al (2001) Relationship of sentinel and axillary level I-II lymph nodes to tangential fields used in breast irradiation. International Journal of Radiation Oncology* Biology*. Physics 51:671–678Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Jason K. Molitoris
    • 1
  • Tejan Diwanji
    • 1
  • James W. Snider
    • 1
  • Emily C. Bellavance
    • 2
  • Susan B. Kesmodel
    • 2
  • Paula Rosenblatt
    • 3
  • Katherine Tkaczuk
    • 3
  • Soren M. Bentzen
    • 4
  • Randi J. Cohen
    • 4
  • Elizabeth M. Nichols
    • 4
  • Sally B. Cheston
    • 4
  • Steven J. Feigenberg
    • 4
    Email author
  1. 1.Department of Radiation OncologyUniversity of Maryland Medical CenterBaltimoreUSA
  2. 2.Department of Surgical OncologyUniversity of Maryland School of MedicineBaltimoreUSA
  3. 3.Department of Medical OncologyUniversity of Maryland School of MedicineBaltimoreUSA
  4. 4.Department of Radiation OncologyUniversity of Maryland School of MedicineBaltimoreUSA

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