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Breast-Conserving Surgery With or Without Radiotherapy in Older Breast Patients With Early Stage Breast Cancer: A Systematic Review and Meta-analysis

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

In early stage breast cancer, radiotherapy is an integral part of locoregional treatment with breast-conserving surgery. However, few older patients are included in the clinical trials upon which these recommendations are based. Therefore, we performed a systematic review and meta-analysis to evaluate outcomes of radiotherapy after breast-conserving surgery in older patients.

Methods

A systematic search of PubMed and Embase was undertaken. Inclusion was restricted to randomized controlled trials in postmenopausal breast cancer patients. Pooled odds ratios were calculated for locoregional recurrence, distant recurrence, and overall survival.

Results

We included 5 randomized clinical trials comprising 3,190 patients. Overall, 39 % of the patients were ≥70 years old, and most had hormone receptor–positive T1 tumors without nodal involvement. All patients received adjuvant systemic therapy. Patients who received radiotherapy had a lower relative risk of locoregional recurrence (pooled odds ratio [OR] 0.36; 95 % confidence interval [CI] 0.25–0.50). The 5-year absolute risk was 2.2 % (95 % CI 1.6–3.1) among patients who received radiotherapy, versus 6.5 % (95 % CI 5.3–7.9) among patients who did not. The absolute risk difference was 4.3 % (95 % CI 2.9–5.7), corresponding with a number needed to treat of 24. No differences were observed for distant recurrence or overall survival.

Conclusions

Although patients who received radiotherapy had a lower relative risk of locoregional recurrence, the absolute risk was low, and overall survival was not affected. We propose that the debate should not only focus on the relative risk but also on the absolute benefit of radiotherapy and the number needed to treat. Both treatment options may be reasonable in clinical practice.

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Acknowledgment

The authors would like to thank the Dutch Cancer Society (KWF 2007-3968) for funding this study.

Disclosure

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Surgical Oncology, Leiden University Medical Center, Leiden, The Netherlands

    Willemien van de Water MD, Esther Bastiaannet PhD, Mandy Kiderlen MD, Cornelis J. H. van de Velde MD, PhD & Gerrit-Jan Liefers MD, PhD

  2. Department of Geriatrics and Gerontology, Leiden University Medical Center, Leiden, The Netherlands

    Willemien van de Water MD, Esther Bastiaannet PhD, Anton J. M. de Craen PhD & Rudi G. J. Westendorp MD, PhD

  3. Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands

    Astrid N. Scholten MD

Authors
  1. Willemien van de Water MD
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  2. Esther Bastiaannet PhD
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  3. Astrid N. Scholten MD
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  4. Mandy Kiderlen MD
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  7. Cornelis J. H. van de Velde MD, PhD
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  8. Gerrit-Jan Liefers MD, PhD
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Correspondence to Gerrit-Jan Liefers MD, PhD.

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van de Water, W., Bastiaannet, E., Scholten, A.N. et al. Breast-Conserving Surgery With or Without Radiotherapy in Older Breast Patients With Early Stage Breast Cancer: A Systematic Review and Meta-analysis. Ann Surg Oncol 21, 786–794 (2014). https://doi.org/10.1245/s10434-013-3374-y

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  • DOI: https://doi.org/10.1245/s10434-013-3374-y

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