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Radiation Therapy After Breast-Conserving Surgery in Women 70 Years of Age and Older: How Wisely Do We Choose?

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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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Authors and Affiliations

  1. Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Stephanie Downs-Canner MD, Tyler Wind BA, Armend Cobovic BS, Monica Morrow MD & Alexandra Heerdt MD

  2. Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Emily C. Zabor MS

  3. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Beryl McCormick MD

Authors
  1. Stephanie Downs-Canner MD
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  2. Emily C. Zabor MS
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  3. Tyler Wind BA
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  4. Armend Cobovic BS
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  5. Beryl McCormick MD
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  6. Monica Morrow MD
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  7. Alexandra Heerdt MD
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Corresponding author

Correspondence to Alexandra Heerdt MD.

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DISCLOSURES

The preparation of this manuscript was funded in part by NIH/NCI Cancer Center Support Grant No. P30 CA008748 to Memorial Sloan Kettering Cancer Center, and this study was presented in poster format at the 71st Society of Surgical Oncology Annual Cancer Symposium, March 21–24, 2018, Chicago, IL. Dr. Monica Morrow has received speaking honoraria from Roche and Genomic Health. The findings presented in this manuscript have not been published elsewhere.

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Downs-Canner, S., Zabor, E.C., Wind, T. et al. Radiation Therapy After Breast-Conserving Surgery in Women 70 Years of Age and Older: How Wisely Do We Choose?. Ann Surg Oncol 26, 969–975 (2019). https://doi.org/10.1245/s10434-018-07151-4

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  • DOI: https://doi.org/10.1245/s10434-018-07151-4

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