A Novel Inclusion Criteria for Radiotherapy Omission in Elderly Breast Cancer Patients with Breast-Conserving Surgery

被引：0
作者：
Heng, Y. L. [1 ]
Xiao, J. [2 ]
Liu, L. Q. [2 ]
Luo, J. [2 ,3 ]
Luo, J. [2 ,3 ]
Chen, J. [2 ]
机构：
[1] Univ Elect Sci & Technol China, Sch Med, Chengdu, Peoples R China
[2] Univ Elect Sci & Technol China, Sichuan Prov Peoples Hosp, Sch Med, Dept Breast Surg, Chengdu 610072, Peoples R China
[3] Univ Elect Sci & Technol China, Sichuan Prov Peoples Hosp, Sch Med, Ultrasound Dept, Chengdu 610072, Peoples R China
来源：
NIGERIAN JOURNAL OF CLINICAL PRACTICE | 2024年 / 27卷 / 12期
关键词：
Breast cancer; breast-conserving surgery; elderly patients; radiotherapy omission; risk stratification; SEER Database; LUMPECTOMY PLUS TAMOXIFEN; 20-YEAR FOLLOW-UP; WOMEN; IRRADIATION; OLDER; AGE; MASTECTOMY; SURVIVAL; THERAPY; BOOST;
D O I：
10.4103/njcp.njcp_79_24
中图分类号：
R5 [内科学];
学科分类号：
1002 ; 100201 ;
摘要：
Background: Breast-conserving surgery (BCS) followed by radiotherapy is the standard treatment for achieving local control and survival benefits in breast cancer patients. However, the necessity of radiotherapy for all elderly patients following BCS is debated due to the potential for overtreatment and the associated risks and side effects, particularly for those at lower risk of recurrence. Aims: This study aims to redefine the criteria for elderly breast cancer patients eligible for radiotherapy omission after BCS, without compromising survival benefits. Methods: Data from breast cancer patients with T1-2N0-1M0 diagnosed between 2010 and 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) program for analysis. Survival analysis was performed using Kaplan-Meier plots and log-rank tests. Univariate and multivariate Cox analyzes were conducted to identify risk factors for breast cancer-specific survival (BCSS). A nomogram and risk stratification model were developed, with a concordance index and calibration curve employed to demonstrate the nomogram's accuracy and predictive capability. Validation of radiotherapy's survival benefit for patients in different risk strata was conducted via subgroup analysis. Results: Histological grade, estrogen receptor status, tumor size, and nodal metastasis stage were identified as independent risk factors for BCSS. These factors were incorporated into a nomogram to predict 3- and 5-year BCSS for patients. Risk stratification indicated that radiotherapy significantly improved BCSS in the high-risk group (HR = 0.540 [0.402-0.724], P < 0.001) but did not in the low-risk (HR = 0.526 [0.154-1.798], P = 0.305) and intermediate-risk groups (HR = 0.588 [0.33-1.05], P = 0.073). Subgroup analysis showed that some patients not meeting the CALGB 9,343 criteria could also be exempt from radiotherapy. Importantly, we found that patients over 80 years of age did not derive a survival benefit from radiotherapy, regardless of clinical characteristics. Conclusions: This study broadens the criteria for radiotherapy omission, potentially assisting clinicians in making radiotherapy decisions for elderly breast cancer patients.
引用
收藏
页码：1417 / 1428
页数：12
相关论文
共 27 条
  • [1] Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, Et al., Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer, N Engl J Med, 347, pp. 1233-1241, (2002)
  • [2] Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans V, Et al., Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: An overview of the randomised trials, Lancet, 366, pp. 2087-2106, (2005)
  • [3] Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, Et al., Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer, N Engl J Med, 347, pp. 1227-1232, (2002)
  • [4] Darby S, McGale P, Correa C, Taylor C, Arriagada R, Clarke M, Et al., Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: Meta-analysis of individual patient data for 10, 801 women in 17 randomised trials, Lancet, 378, pp. 1707-1716, (2011)
  • [5] Bartelink H, Horiot JC, Poortmans PM, Struikmans H, Van den Bogaert W, Fourquet A, Et al., Impact of a higher radiation dose on local control and survival in breast-conserving therapy of early breast cancer: 10-year results of the randomized boost versus no boost EORTC 22881-10882 trial, J Clin Oncol, 25, pp. 3259-3265, (2007)
  • [6] Diab SG, Elledge RM, Clark GM., Tumor characteristics and clinical outcome of elderly women with breast cancer, J Natl Cancer Inst, 92, pp. 550-556, (2000)
  • [7] Gennari R, Curigliano G, Rotmensz N, Robertson C, Colleoni M, Zurrida S, Et al., Breast carcinoma in elderly women: Features of disease presentation, choice of local and systemic treatments compared with younger postmenopasual patients, Cancer, 101, pp. 1302-1310, (2004)
  • [8] Davies C, Godwin J, Gray R, Clarke M, Cutter D, Darby S, Et al., Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: Patient-level meta-analysis of randomised trials, Lancet, 378, pp. 771-784, (2011)
  • [9] Girones R, Torregrosa D, Diaz-Beveridge R., Comorbidity, disability and geriatric syndromes in elderly breast cancer survivors. Results of a single-center experience, Crit Rev Oncol Hematol, 73, pp. 236-245, (2010)
  • [10] van de Water W, Markopoulos C, van de Velde CJ, Seynaeve C, Hasenburg A, Rea D, Et al., Association between age at diagnosis and disease-specific mortality among postmenopausal women with hormone receptor-positive breast cancer, JAMA, 307, pp. 590-597, (2012)
123