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Annals of Surgical Oncology

, Volume 25, Issue 6, pp 1495–1501 | Cite as

Treatment Strategies in Octogenarians with Early-Stage, High-Risk Breast Cancer

  • Anita Mamtani
  • Julie J. Gonzalez
  • Dayna T. Neo
  • Robb S. Friedman
  • Abram Recht
  • Michele R. Hacker
  • Ranjna Sharma
Breast Oncology

Abstract

Background

Octogenarians with early-stage breast cancer often have low-risk tumor biology. However, optimal treatment strategies for those with high-risk biology remain unclear.

Methods

We reviewed the records of women ages 80–89 years with biopsy-proven, Stage I–II invasive breast cancer who were referred for surgical evaluation from January 2001 through December 2010. High-risk was defined as human epidermal growth factor receptor-positive (HER2+), triple-negative (TN), or histologic grade 3 disease.

Results

Among 178 patients, 40 (22%) were high-risk: 12 were grade 1–2 (10 HER2 + , 2 TN); 28 were grade 3 (7 HER2+, 6 TN, 15 estrogen receptor-positive (ER+)/HER2−). The high-risk group had larger tumors and more often had ductal histology and lymphovascular invasion than the low-risk group and was more likely to undergo mastectomy (18 vs. 5%, p = 0.02), radiotherapy (55 vs. 36%, p = 0.03), and chemotherapy (10 vs. 0%, p = 0.002). Endocrine therapy use was similar among ER+ patients in both groups. The four patients in the high-risk group given chemotherapy were HER2+ and received trastuzumab-based regimens, without any reported toxicities. At median follow-up of 67 months, 10% of the high-risk group had a recurrence (3 distant-only, 1 simultaneous locoregional and distant in a patient treated with mastectomy without radiotherapy).

Conclusions

Tailored locoregional and systemic therapy resulted in low incidence of failure in these octogenarians with high-risk cancers with low morbidity. Modern adjuvant therapies should be considered for elderly women with high-risk cancers in the absence of significant comorbidities.

Notes

Acknowledgments

This work was conducted with support from Harvard Catalyst | The Harvard Clinical and Translational Science Center (National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health Award UL1 TR001102) and financial contributions from Harvard University and its affiliated academic healthcare centers. The findings presented in this manuscript have not been published elsewhere.

Disclosures

The authors have no conflicts of interest to declare.

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Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Anita Mamtani
    • 1
  • Julie J. Gonzalez
    • 1
  • Dayna T. Neo
    • 2
  • Robb S. Friedman
    • 3
  • Abram Recht
    • 4
  • Michele R. Hacker
    • 5
  • Ranjna Sharma
    • 1
  1. 1.Department of SurgeryBeth Israel Deaconess Medical Center, Harvard Medical SchoolBostonUSA
  2. 2.Department of Obstetrics and GynecologyBeth Israel Deaconess Medical CenterBostonUSA
  3. 3.Department of Medical OncologyMassachusetts General Hospital Cancer Center, Harvard Medical SchoolBostonUSA
  4. 4.Department of Radiation OncologyBeth Israel Deaconess Medical Center, Harvard Medical SchoolBostonUSA
  5. 5.Department of Obstetrics and GynecologyBeth Israel Deaconess Medical Center, Harvard Medical SchoolBostonUSA

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