Omission of radiotherapy in elderly patients with early breast cancer: 15-Year results of a prospective non-randomised trial

Gabriele Martelli, Patrizia Boracchi, Eleonora Guzzetti, Giuseppe Marano, Laura Lozza, Roberto Agresti, Cristina Ferraris, Domenico Piromalli, Marco Greco

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Whether radiotherapy (RT) is beneficial in elderly (≥70. years) patients undergoing conservative surgery for early breast cancer has long been controversial. Recent randomised trials show that most elderly patients do not benefit from RT. We started a prospective non-randomised trial to address this issue in 1987 and now present results for the 627 consecutive pT1/2cN0 patients recruited, and treated by conservative surgery (quadrantectomy) and tamoxifen, and assigned non-randomly to RT or no RT. Methods: We used multivariate competing risks models to estimate 15-crude cumulative incidence (CCI) of ipsilateral breast tumour recurrence (IBTR), distant metastasis and breast cancer mortality. The models incorporated a propensity score as a measure of probability of receiving RT based on baseline characteristics, to account for the lack of randomisation. Results: For pT1 patients, 15-year CCIs of IBTR, distant metastasis and breast cancer death were indistinguishable in the RT and no RT groups. For pT2 patients, 15-year CCI of IBTR was much higher in those not given RT (14.6% versus 0.8%, p = 0.004), although breast cancer mortality and distant metastasis did not differ significantly between RT and no RT. Conclusions: Consistent with the findings of recent randomised trials, our long-term data indicate that most elderly, ER-positive patients with pT1 cN0 breast cancer treated by quadrantectomy do not benefit from RT. The 14.6% CCI of IBTR in our pT2 patients is an additional finding not presented in the trials and suggests that RT should be administered to elderly patients with pT2 disease.

Original languageEnglish
JournalEuropean Journal of Cancer
Volume51
Issue number11
DOIs
Publication statusPublished - Jun 8 2015

Keywords

  • Breast cancer
  • Breast-conserving surgery
  • Elderly patients
  • Quadrantectomy
  • Radiotherapy
  • Tamoxifen

ASJC Scopus subject areas

  • Medicine(all)
  • Oncology
  • Cancer Research

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