Adjuvant Radiotherapy Is Associated with an Increase in the Survival of Old (Aged over 80 Years) and Very Old (Aged over 90 Years) Women with Breast Cancer Receiving Breast-Conserving Surgery.

Chung-Chien Huang,Shao-Yin Sum,Szu-Yuan Wu,Jiaqiang Zhang,Chia-Lun Chang,Ming-Feng Chiang,Mingyang Sun

doi:10.3390/jpm12020287

Abstract

This study is the first to examine the effect of adjuvant whole-breast radiotherapy (WBRT) on oncologic outcomes such as all-cause death, locoregional recurrence (LRR), and distant metastasis (DM) in old (aged ≥80 years) and very old (aged ≥90 years) women with breast invasive ductal carcinoma (IDC) receiving breast-conserving surgery. After propensity score matching, adjuvant WBRT was associated with decreases in all-cause death, LRR, and DM in old and very old women with IDC compared with no use of adjuvant WBRT. Background: To date, no data on the effect of adjuvant whole-breast radiotherapy (WBRT) on oncologic outcomes, such as all-cause death, locoregional recurrence (LRR), and distant metastasis (DM), are available for old (aged ≥80 years) and very old (≥90 years) women with breast invasive ductal carcinoma (IDC) receiving breast-conserving conservative surgery (BCS). Patients and Methods: We enrolled old (≥80 years old) and very old (≥90 years old) women with breast IDC who had received BCS followed by adjuvant WBRT or no adjuvant WBRT. We grouped them based on adjuvant WBRT status and compared their overall survival (OS), LRR, and DM outcomes. To reduce the effects of potential confounders when comparing all-cause mortality between the groups, propensity score matching was performed. Results: Overall, 752 older women with IDC received BCS followed by adjuvant WBRT, and 752 with IDC received BCS with no adjuvant WBRT. In multivariable Cox regression analysis, the adjusted hazard ratio (aHR) and 95% confidence interval (95% CI) of all-cause death for adjuvant WBRT compared with no adjuvant WBRT in older women with IDC receiving BCS was 0.56 (0.44–0.70). The aHRs (95% CIs) of LRR and DM for adjuvant WBRT were 0.29 (0.19–0.45) and 0.45 (0.32–0.62), respectively, compared with no adjuvant WBRT. Conclusions: Adjuvant WBRT was associated with decreases in all-cause death, LRR, and DM in old (aged ≥80 years) and very old (aged ≥90 years) women with IDC compared with no adjuvant WBRT.

Highlights

Standard treatments based on cancer treatment guidelines such as the National Comprehensive Cancer Network (NCCN) guidelines are not suitable for every older patient, because many randomized controlled trials (RCTs) for breast cancer therapy do not enroll patients ≥65 years old [1]
After applying the inclusion and exclusion criteria, we divided the population into two groups based on their adjuvant whole-breast radiotherapy (WBRT) status to compare all-cause mortality: Group 1 and Group 2
752 received breastconserving conservative surgery (BCS) followed by adjuvant WBRT (Group 1) and 752 with invasive ductal carcinoma (IDC) received BCS without adjuvant WBRT (Group 2)

Summary

Introduction

Standard treatments based on cancer treatment guidelines such as the National Comprehensive Cancer Network (NCCN) guidelines are not suitable for every older patient, because many randomized controlled trials (RCTs) for breast cancer therapy do not enroll patients ≥65 years old [1]. Determining optimal treatments for older cancer patients is challenging, especially for those aged 80 years or more. Older patients (≥80 years) constitute a substantial percentage of those with breast cancer [5]. One in four patients with breast cancer are aged more than 65 years, and approximately 10% of the total breast cancer population is 80 years or older [5]. This age group often presents challenges in terms of treatment because of comorbidities and frailty [6]

Methods

Results

Conclusion