Cancer Res Treat.  2019 Jan;51(1):326-336. 10.4143/crt.2018.163.

Omitting Adjuvant Radiotherapy for Hormone Receptor‒Positive Early-Stage Breast Cancer in Old Age: A Propensity Score Matched SEER Analysis

• Kim YJ
• Shin KH
• Kim K

• KMID: 2437623
• DOI: http://doi.org/10.4143/crt.2018.163

Abstract

PURPOSE
The purpose of this study was to investigate the non-inferiority of omitting radiotherapy (RT) after breast-conserving surgery (BCS) for hormone receptor (HR)"’positive T1N0 breast cancer in elderly women.
MATERIALS AND METHODS
From 2004 to 2014, HR-positive T1N0 breast cancer patients aged 50 years or older and receiving BCS were retrieved from the Surveillance, Epidemiology, and End
RESULTS
18 database. After propensity score matching between the no-RT and RT groups, univariate and multivariate analyses were performed. Identified prognostic factors were used to stratify the risk groups. In each risk group, 10-year cancer-specific survival (CSS) rates were compared between the no-RT and RT groups.
RESULTS
After propensity score matching, the numbers of patients in the no-RT and RT groups were both 18,586. For patients who satisfied both a tumor size of 1-10 mm and a tumor grade of 1-2, omitting RT did not decrease the CSS rate at any age group, ranging from ≥ 50 to ≥ 85 years; for patients aged ≥ 50 years, the 10-year CSS rates in the no-RT and RT groups were 97.2% and 96.8%, respectively (adjusted hazard ratio, 0.862; p=0.312). However, for patients with a tumor size of 11-20 mm or tumor grade of 3-4, RT significantly increased the CSS rate irrespective of age.
CONCLUSION
RT after BCS for HR-positive T1N0 breast cancer in elderly women might be omitted without causing a decrease in the CSS rate, but only in patients who satisfy both a small tumor size (≤ 10 mm) and low tumor grade (1-2).

Keyword

Adjuvant radiotherapy; Aged; Breast neoplasms; SEER database; Estrogen receptors; Progesterone receptors; Tumor grade; Tumor size

MeSH Terms

Aged
Breast Neoplasms*
Breast*
Epidemiology
Female
Humans
Mastectomy, Segmental
Multivariate Analysis
Propensity Score*
Radiotherapy
Radiotherapy, Adjuvant*
Receptors, Estrogen
Receptors, Progesterone
Receptors, Estrogen
Receptors, Progesterone

Figure

• 

  Fig. 1. Kaplan-Meier estimates of the cancer-specific survival (CSS) rate of patients with hormone receptor‒positive T1N0 breast cancer aged ≥ 50 years according to whether adjuvant radiotherapy (RT) after breast conserving surgery was received or not. (A) Tumor size 1-10 mm and tumor grade 1-2. (B) Tumor size 11-20 mm and tumor grade 1-2. (C) Tumor size 1-10 mm and tumor grade 3-4. (D) Tumor size 11-20 mm and tumor grade 3-4.

• 

  Fig. 2. Kaplan-Meier estimates of the cancer-specific survival (CSS) rate of patients with hormone receptor‒positive T1N0 breast cancer aged ≥ 65 years according to whether adjuvant radiotherapy (RT) after breast conserving surgery was received or not. (A) Tumor size 1-10 mm and tumor grade 1-2. (B) Tumor size 11-20 mm and tumor grade 1-2. (C) Tumor size 1-10 mm and tumor grade 3-4. (D) Tumor size 11-20 mm and tumor grade 3-4.

Reference

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