Abstract
Purpose
The aim of this study was to verify if radiotherapy (RT) safely can be omitted in
older women treated for estrogen-receptor positive early breast cancer with breast-conserving
surgery (BCS) and endocrine therapy (ET).
Patients and Methods
Eligibility criteria were: consecutive patients with age ≥65 years, BCS + sentinel
node biopsy, clear margins, unifocal T1N0M0 breast cancer tumor, Elston-Ellis histological
grade 1 or 2 and estrogen receptor-positive tumor. After informed consent, adjuvant
ET for 5 years was prescribed. Primary endpoint was ipsilateral breast tumor recurrence
(IBTR). Secondary endpoints were contralateral breast cancer and overall survival.
Results
Between 2006 and 2012, 603 women were included from 14 Swedish centers. Median age
was 71.1 years (range 65–90). After a median follow-up of 68 months 16 IBTR (cumulative
incidence at five-year follow-up; 1.2%, 95% CI, 0.6% to 2.5%), 6 regional recurrences
(one combined with IBTR), 2 distant recurrences (both without IBTR or regional recurrence)
and 13 contralateral breast cancers were observed. There were 48 deaths. One death
(2.1%) was due to breast cancer and 13 (27.1%) were due to other cancers (2 endometrial
cancers). Five-year overall survival was 93.0% (95% CI, 90.5% to 94.9%).
Conclusion
BCS and ET without RT seem to be a safe treatment option in women ≥ 65 years with
early breast cancer and favorable histopathology. The risk of IBTR is comparable to
the risk of contralateral breast cancer. Moreover, concurrent morbidity dominates
over breast cancer as leading cause of death in this cohort with low-risk breast tumors.
Keywords
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Article info
Publication history
Published online: April 12, 2018
Accepted:
April 5,
2018
Footnotes
☆The study has previously been presented as a poster at the breast cancer conference in San Antonio, December 2016.
Identification
Copyright
© 2018 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
