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Radiation and/or endocrine therapy? Recurrence and survival outcomes in women over 70 with early breast cancer after breast-conserving surgery

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

Women over 70 with early breast cancer treated with breast-conserving surgery are typically offered adjuvant endocrine and radiation therapy. Prior studies have supported the omission of adjuvant radiation in this low-risk population. We sought to compare the effect of adjuvant treatment with endocrine therapy alone, radiation therapy alone or both versus no adjuvant treatment on local control and survival in this population.

Methods

Data were extracted on 1363 breast cancer patients over the age of 70 treated with a breast-conserving surgery from 2003 until 2018. 460 patients met inclusion criteria of pT1N0, invasive disease with negative margins and not treated with chemotherapy. The primary outcome of this population-based study was local recurrence-free survival at 5 and 10 years.

Results

Patients receiving no adjuvant therapy had worse local recurrence-free, loco-regional recurrence-free and disease-free survival than patients receiving at least one form of adjuvant therapy (p < 0.05). 5-year local recurrence rates were 0.8% in patients receiving both endocrine and radiation therapy, 1.5% in those receiving radiation alone, 4.2% in those receiving endocrine therapy alone and 12% in those receiving no adjuvant therapy.

Conclusions

This study supports the benefit of some form of adjuvant therapy (radiation alone, endocrine therapy alone or both) in low-risk breast cancer patients over 70. Receiving no adjuvant therapy is associated with poorer outcomes. Many of these patients are candidates for Accelerated Partial Breast Irradiation which can be completed in less than a week. These patients should be offered radiation therapy, endocrine therapy or both.

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Data availability

The datasets generated during and/or analyzed during the current study are not publicly available due patient privacy but de-identified data are available from the corresponding author on reasonable request.

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Funding

No funding source was used for this study.

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Dalhousie University, 5820 University Avenue, Halifax, NS, B3H 1V7, Canada

    Hannah Dahn, Derek Wilke & Jean-Philippe Pignol

  2. Cancer Registry & Analytics Unit, NSHA Cancer Care Program, QEII Health Sciences Centre, Room 556, Bethune Building, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada

    Gordon Walsh

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  1. Hannah Dahn
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  4. Jean-Philippe Pignol
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Contributions

JPP, HD and GW conceived the study and contributed to study design. HD and DW performed analysis. HD and GW contributed to data collection. HD, DW, JPP contributed to interpretation of the results. HD wrote the manuscript and all authors critically reviewed the finalized report. All authors agreed with the decision to submit for publication.

Corresponding author

Correspondence to Jean-Philippe Pignol.

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All authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Dahn, H., Wilke, D., Walsh, G. et al. Radiation and/or endocrine therapy? Recurrence and survival outcomes in women over 70 with early breast cancer after breast-conserving surgery. Breast Cancer Res Treat 182, 411–420 (2020). https://doi.org/10.1007/s10549-020-05691-6

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  • DOI: https://doi.org/10.1007/s10549-020-05691-6

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