Effect of adjuvant radiotherapy in elderly patients with breast cancer
Radiotherapy (RT) is of critical importance in the locoregional management of early breast cancer. Although RT is routinely used following breast conserving surgery (BCS), patients may occasionally be effectively treated with BCS alone. Currently, the selection of patients undergoing BCS who do not...
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| description | Radiotherapy (RT) is of critical importance in the locoregional management of early breast cancer. Although RT is routinely used following breast conserving surgery (BCS), patients may occasionally be effectively treated with BCS alone. Currently, the selection of patients undergoing BCS who do not need breast irradiation is under investigation. With the advancement of personalized medicine, there is an increasing interest in reduction of aggressive treatments especially in older women. The primary objective of this study was to identify elderly patients who may forego breast irradiation after BCS without measurable consequences on local tumor growth and survival.
We analyzed 2384 early breast cancer patients aged 70 and older who were treated in 17 German certified breast cancer centers between 2001 and 2009. We compared RT versus no RT after guideline adherent (GA) BCS. The outcomes studied were breast cancer recurrence (RFS) and breast cancer-specific survival (BCSS). Low-risk patients were defined by luminal A, tumor size T1 or T2 and node-negative whereas higher-risk patients were defined by patients with G3 or T3/T4 or node-positive or other than Luminal A tumors. To test if there is a difference between two or more survival curves, we used the Gp family of tests of Harrington and Fleming.
The median age was 77 yrs (mean 77.6±5.6 y) and the median observation time 46 mths (mean 48.9±24.8 mths). 950 (39.8%) patients were low-risk and 1434 (60.2%) were higher-risk. 1298 (54.4%) patients received GA BCS of which 85.0% (1103) received GA-RT and only 15% (195) did not. For low-risk patients with GA-BCS there were no significant differences in RFS (log rank p = 0.651) and in BCSS (p = 0.573) stratified by GA-RT. 5 years RFS in both groups were > 97%. For higher-risk patients with GA-BCS we found a significant difference (p |
| doi_str_mv | 10.1371/journal.pone.0229518 |
| format | Article |
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We analyzed 2384 early breast cancer patients aged 70 and older who were treated in 17 German certified breast cancer centers between 2001 and 2009. We compared RT versus no RT after guideline adherent (GA) BCS. The outcomes studied were breast cancer recurrence (RFS) and breast cancer-specific survival (BCSS). Low-risk patients were defined by luminal A, tumor size T1 or T2 and node-negative whereas higher-risk patients were defined by patients with G3 or T3/T4 or node-positive or other than Luminal A tumors. To test if there is a difference between two or more survival curves, we used the Gp family of tests of Harrington and Fleming.
The median age was 77 yrs (mean 77.6±5.6 y) and the median observation time 46 mths (mean 48.9±24.8 mths). 950 (39.8%) patients were low-risk and 1434 (60.2%) were higher-risk. 1298 (54.4%) patients received GA BCS of which 85.0% (1103) received GA-RT and only 15% (195) did not. For low-risk patients with GA-BCS there were no significant differences in RFS (log rank p = 0.651) and in BCSS (p = 0.573) stratified by GA-RT. 5 years RFS in both groups were > 97%. For higher-risk patients with GA-BCS we found a significant difference (p<0.001) in RFS and tumor-associated OS stratified by GA-RT. The results remain the same after adjusting by adjuvant systemic treatment (AST) and comorbidity (ASA and NYHA).
Patients aged 70 years and older suffering from low-risk early breast cancer with GA-BCS can avoid breast irradiation with <3% chance of relapse. In the case of higher-risk, breast irradiation should be used routinely following GA-BCS. As a side effect of these results, removing the entire breast of elderly low risk patients to spare them from breast irradiation seems to be not necessary.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0229518</identifier><identifier>PMID: 32434215</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Aged ; Aged, 80 and over ; Breast cancer ; Breast Neoplasms - drug therapy ; Breast Neoplasms - pathology ; Breast Neoplasms - radiotherapy ; Breast Neoplasms - surgery ; Cancer patients ; Cancer recurrence ; Cancer research ; Cancer therapies ; Care and treatment ; Cell growth ; College football ; Combined Modality Therapy ; Comorbidity ; Confidence intervals ; Disease-Free Survival ; Elderly ; Elderly patients ; Evidence-based medicine ; Female ; Geriatrics ; Gynecology ; Health risks ; Humans ; Irradiation ; Lumpectomy ; Lymphatic Metastasis ; Mastectomy ; Mastectomy, Segmental ; Medical research ; Medical schools ; Medicine and Health Sciences ; Middle aged women ; Mortality ; Neoplasm Recurrence, Local - drug therapy ; Neoplasm Recurrence, Local - pathology ; Neoplasm Recurrence, Local - radiotherapy ; Neoplasm Recurrence, Local - surgery ; Obstetrics ; Older people ; Patient outcomes ; Patients ; People and Places ; Precision medicine ; Radiation therapy ; Radiotherapy ; Radiotherapy, Adjuvant ; Recurrence (Disease) ; Risk ; Risk Factors ; Risk groups ; Suffering ; Surgery ; Survival ; Time ; Tumors ; Women</subject><ispartof>PloS one, 2020-05, Vol.15 (5), p.e0229518-e0229518</ispartof><rights>COPYRIGHT 2020 Public Library of Science</rights><rights>2020 Stueber et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2020 Stueber et al 2020 Stueber et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-39145211439061f36fc2268d7d5355bc7fb13622ab35fc29a8ef572e1a2918eb3</citedby><cites>FETCH-LOGICAL-c692t-39145211439061f36fc2268d7d5355bc7fb13622ab35fc29a8ef572e1a2918eb3</cites><orcidid>0000-0003-0145-5739</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7239665/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7239665/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2095,2914,23846,27903,27904,53769,53771,79346,79347</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32434215$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Zhang, Lanjing</contributor><creatorcontrib>Stueber, Tanja Nadine</creatorcontrib><creatorcontrib>Diessner, Joachim</creatorcontrib><creatorcontrib>Bartmann, Catharina</creatorcontrib><creatorcontrib>Leinert, Elena</creatorcontrib><creatorcontrib>Janni, Wolfgang</creatorcontrib><creatorcontrib>Herr, Daniel</creatorcontrib><creatorcontrib>Kreienberg, Rolf</creatorcontrib><creatorcontrib>Woeckel, Achim</creatorcontrib><creatorcontrib>Wischnewsky, Manfred</creatorcontrib><title>Effect of adjuvant radiotherapy in elderly patients with breast cancer</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Radiotherapy (RT) is of critical importance in the locoregional management of early breast cancer. Although RT is routinely used following breast conserving surgery (BCS), patients may occasionally be effectively treated with BCS alone. Currently, the selection of patients undergoing BCS who do not need breast irradiation is under investigation. With the advancement of personalized medicine, there is an increasing interest in reduction of aggressive treatments especially in older women. The primary objective of this study was to identify elderly patients who may forego breast irradiation after BCS without measurable consequences on local tumor growth and survival.
We analyzed 2384 early breast cancer patients aged 70 and older who were treated in 17 German certified breast cancer centers between 2001 and 2009. We compared RT versus no RT after guideline adherent (GA) BCS. The outcomes studied were breast cancer recurrence (RFS) and breast cancer-specific survival (BCSS). Low-risk patients were defined by luminal A, tumor size T1 or T2 and node-negative whereas higher-risk patients were defined by patients with G3 or T3/T4 or node-positive or other than Luminal A tumors. To test if there is a difference between two or more survival curves, we used the Gp family of tests of Harrington and Fleming.
The median age was 77 yrs (mean 77.6±5.6 y) and the median observation time 46 mths (mean 48.9±24.8 mths). 950 (39.8%) patients were low-risk and 1434 (60.2%) were higher-risk. 1298 (54.4%) patients received GA BCS of which 85.0% (1103) received GA-RT and only 15% (195) did not. For low-risk patients with GA-BCS there were no significant differences in RFS (log rank p = 0.651) and in BCSS (p = 0.573) stratified by GA-RT. 5 years RFS in both groups were > 97%. For higher-risk patients with GA-BCS we found a significant difference (p<0.001) in RFS and tumor-associated OS stratified by GA-RT. The results remain the same after adjusting by adjuvant systemic treatment (AST) and comorbidity (ASA and NYHA).
Patients aged 70 years and older suffering from low-risk early breast cancer with GA-BCS can avoid breast irradiation with <3% chance of relapse. In the case of higher-risk, breast irradiation should be used routinely following GA-BCS. As a side effect of these results, removing the entire breast of elderly low risk patients to spare them from breast irradiation seems to be not necessary.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Breast cancer</subject><subject>Breast Neoplasms - drug therapy</subject><subject>Breast Neoplasms - pathology</subject><subject>Breast Neoplasms - radiotherapy</subject><subject>Breast Neoplasms - surgery</subject><subject>Cancer patients</subject><subject>Cancer recurrence</subject><subject>Cancer research</subject><subject>Cancer therapies</subject><subject>Care and treatment</subject><subject>Cell growth</subject><subject>College football</subject><subject>Combined Modality Therapy</subject><subject>Comorbidity</subject><subject>Confidence intervals</subject><subject>Disease-Free Survival</subject><subject>Elderly</subject><subject>Elderly patients</subject><subject>Evidence-based medicine</subject><subject>Female</subject><subject>Geriatrics</subject><subject>Gynecology</subject><subject>Health risks</subject><subject>Humans</subject><subject>Irradiation</subject><subject>Lumpectomy</subject><subject>Lymphatic Metastasis</subject><subject>Mastectomy</subject><subject>Mastectomy, Segmental</subject><subject>Medical research</subject><subject>Medical schools</subject><subject>Medicine and Health Sciences</subject><subject>Middle aged women</subject><subject>Mortality</subject><subject>Neoplasm Recurrence, Local - drug therapy</subject><subject>Neoplasm Recurrence, Local - pathology</subject><subject>Neoplasm Recurrence, Local - radiotherapy</subject><subject>Neoplasm Recurrence, Local - surgery</subject><subject>Obstetrics</subject><subject>Older people</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>People and Places</subject><subject>Precision medicine</subject><subject>Radiation therapy</subject><subject>Radiotherapy</subject><subject>Radiotherapy, Adjuvant</subject><subject>Recurrence (Disease)</subject><subject>Risk</subject><subject>Risk Factors</subject><subject>Risk groups</subject><subject>Suffering</subject><subject>Surgery</subject><subject>Survival</subject><subject>Time</subject><subject>Tumors</subject><subject>Women</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNqNkl1rFDEUhgdRbK3-A9EBQfRi18n3zI1QSqsLhYJft-FMJtnNkp2sSaa6_96sOy070gvJRcLJc96Tc_IWxUtUzRER6MPaD6EHN9_6Xs8rjBuG6kfFKWoInnFckcdH55PiWYzrqmKk5vxpcUIwJRQjdlpcXRqjVSq9KaFbD7fQpzJAZ31a6QDbXWn7UrtOB7crt5Cs7lMsf9m0KtugIaZSQa90eF48MeCifjHuZ8X3q8tvF59n1zefFhfn1zPFG5xmpEGUYYQoaSqODOFGYczrTnSMMNYqYVpEOMbQEpavGqi1YQJrBLhBtW7JWfH6oLt1PspxBFFiWrGsk1UzsTgQnYe13Aa7gbCTHqz8G_BhKSEkq5yWCiNsDAYuQFBS07aBBhghQhNoW9FkrY9jtaHd6E7l5gO4iej0prcrufS3UmDScM6ywLtRIPifg45JbmxU2jnotR8O7yaYV5xk9M0_6MPdjdQScgO2Nz7XVXtRec4xpYIJRjM1f4DKq9Mbq7JfjM3xScL7SUJmkv6dljDEKBdfv_w_e_Njyr49YlcaXFpF74ZkfR-nID2AKvgYgzb3Q0aV3Nv9bhpyb3c52j2nvTr-oPukO3-TP5Ro-Kg</recordid><startdate>20200520</startdate><enddate>20200520</enddate><creator>Stueber, Tanja Nadine</creator><creator>Diessner, Joachim</creator><creator>Bartmann, Catharina</creator><creator>Leinert, Elena</creator><creator>Janni, Wolfgang</creator><creator>Herr, Daniel</creator><creator>Kreienberg, Rolf</creator><creator>Woeckel, Achim</creator><creator>Wischnewsky, Manfred</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0003-0145-5739</orcidid></search><sort><creationdate>20200520</creationdate><title>Effect of adjuvant radiotherapy in elderly patients with breast cancer</title><author>Stueber, Tanja Nadine ; Diessner, Joachim ; Bartmann, Catharina ; Leinert, Elena ; Janni, Wolfgang ; Herr, Daniel ; Kreienberg, Rolf ; Woeckel, Achim ; Wischnewsky, Manfred</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-39145211439061f36fc2268d7d5355bc7fb13622ab35fc29a8ef572e1a2918eb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Breast cancer</topic><topic>Breast Neoplasms - 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Academic</collection><collection>ProQuest Engineering Collection</collection><collection>ProQuest Biological Science Collection</collection><collection>Agricultural Science Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>Engineering Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Environmental Science Database</collection><collection>Materials Science Collection</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>Engineering Collection</collection><collection>Environmental Science Collection</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Stueber, Tanja Nadine</au><au>Diessner, Joachim</au><au>Bartmann, Catharina</au><au>Leinert, Elena</au><au>Janni, Wolfgang</au><au>Herr, Daniel</au><au>Kreienberg, Rolf</au><au>Woeckel, Achim</au><au>Wischnewsky, Manfred</au><au>Zhang, Lanjing</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of adjuvant radiotherapy in elderly patients with breast cancer</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2020-05-20</date><risdate>2020</risdate><volume>15</volume><issue>5</issue><spage>e0229518</spage><epage>e0229518</epage><pages>e0229518-e0229518</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Radiotherapy (RT) is of critical importance in the locoregional management of early breast cancer. Although RT is routinely used following breast conserving surgery (BCS), patients may occasionally be effectively treated with BCS alone. Currently, the selection of patients undergoing BCS who do not need breast irradiation is under investigation. With the advancement of personalized medicine, there is an increasing interest in reduction of aggressive treatments especially in older women. The primary objective of this study was to identify elderly patients who may forego breast irradiation after BCS without measurable consequences on local tumor growth and survival.
We analyzed 2384 early breast cancer patients aged 70 and older who were treated in 17 German certified breast cancer centers between 2001 and 2009. We compared RT versus no RT after guideline adherent (GA) BCS. The outcomes studied were breast cancer recurrence (RFS) and breast cancer-specific survival (BCSS). Low-risk patients were defined by luminal A, tumor size T1 or T2 and node-negative whereas higher-risk patients were defined by patients with G3 or T3/T4 or node-positive or other than Luminal A tumors. To test if there is a difference between two or more survival curves, we used the Gp family of tests of Harrington and Fleming.
The median age was 77 yrs (mean 77.6±5.6 y) and the median observation time 46 mths (mean 48.9±24.8 mths). 950 (39.8%) patients were low-risk and 1434 (60.2%) were higher-risk. 1298 (54.4%) patients received GA BCS of which 85.0% (1103) received GA-RT and only 15% (195) did not. For low-risk patients with GA-BCS there were no significant differences in RFS (log rank p = 0.651) and in BCSS (p = 0.573) stratified by GA-RT. 5 years RFS in both groups were > 97%. For higher-risk patients with GA-BCS we found a significant difference (p<0.001) in RFS and tumor-associated OS stratified by GA-RT. The results remain the same after adjusting by adjuvant systemic treatment (AST) and comorbidity (ASA and NYHA).
Patients aged 70 years and older suffering from low-risk early breast cancer with GA-BCS can avoid breast irradiation with <3% chance of relapse. In the case of higher-risk, breast irradiation should be used routinely following GA-BCS. As a side effect of these results, removing the entire breast of elderly low risk patients to spare them from breast irradiation seems to be not necessary.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>32434215</pmid><doi>10.1371/journal.pone.0229518</doi><tpages>e0229518</tpages><orcidid>https://orcid.org/0000-0003-0145-5739</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2020-05, Vol.15 (5), p.e0229518-e0229518 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2405268390 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Public Library of Science (PLoS); PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Aged Aged, 80 and over Breast cancer Breast Neoplasms - drug therapy Breast Neoplasms - pathology Breast Neoplasms - radiotherapy Breast Neoplasms - surgery Cancer patients Cancer recurrence Cancer research Cancer therapies Care and treatment Cell growth College football Combined Modality Therapy Comorbidity Confidence intervals Disease-Free Survival Elderly Elderly patients Evidence-based medicine Female Geriatrics Gynecology Health risks Humans Irradiation Lumpectomy Lymphatic Metastasis Mastectomy Mastectomy, Segmental Medical research Medical schools Medicine and Health Sciences Middle aged women Mortality Neoplasm Recurrence, Local - drug therapy Neoplasm Recurrence, Local - pathology Neoplasm Recurrence, Local - radiotherapy Neoplasm Recurrence, Local - surgery Obstetrics Older people Patient outcomes Patients People and Places Precision medicine Radiation therapy Radiotherapy Radiotherapy, Adjuvant Recurrence (Disease) Risk Risk Factors Risk groups Suffering Surgery Survival Time Tumors Women |
| title | Effect of adjuvant radiotherapy in elderly patients with breast cancer |
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