TY - JOUR
T1 - Omission of radiotherapy in elderly patients with early breast cancer
T2 - 15-Year results of a prospective non-randomised trial
AU - Martelli, Gabriele
AU - Boracchi, Patrizia
AU - Guzzetti, Eleonora
AU - Marano, Giuseppe
AU - Lozza, Laura
AU - Agresti, Roberto
AU - Ferraris, Cristina
AU - Piromalli, Domenico
AU - Greco, Marco
PY - 2015/6/8
Y1 - 2015/6/8
N2 - 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.
AB - 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.
KW - Breast cancer
KW - Breast-conserving surgery
KW - Elderly patients
KW - Quadrantectomy
KW - Radiotherapy
KW - Tamoxifen
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U2 - 10.1016/j.ejca.2015.04.018
DO - 10.1016/j.ejca.2015.04.018
M3 - Article
C2 - 26003208
AN - SCOPUS:84934898282
VL - 51
JO - European Journal of Cancer
JF - European Journal of Cancer
SN - 0959-8049
IS - 11
ER -