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Radiotherapy after breast‐conserving surgery for elderly patients with early‐stage breast cancer: A national registry‐based study
Author(s) -
Wang Fei,
Meszoely Ingrid,
Pal Tuya,
Mayer Ingrid A,
Bailey Christina E.,
Zheng Wei,
Shu XiaoOu
Publication year - 2020
Publication title -
international journal of cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.475
H-Index - 234
eISSN - 1097-0215
pISSN - 0020-7136
DOI - 10.1002/ijc.33265
Subject(s) - medicine , radiation therapy , breast cancer , hazard ratio , proportional hazards model , breast conserving surgery , stage (stratigraphy) , cancer registry , cancer , surgery , oncology , confidence interval , mastectomy , gynecology , paleontology , biology
Considerable controversies exist regarding whether elderly patients with early‐stage breast cancer receiving breast‐conserving surgery (BCS) should forgo radiotherapy. We utilized the National Cancer Database to analyze data of 115 516 women aged ≥70 years, treated with BCS for T1‐2N0‐1M0 breast cancer between 2004 and 2014. Multivariable Cox proportional hazards model was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for mortality 3, 5 and 10 years after 90 days of BCS associated with radiotherapy. Patients who received no radiotherapy had a higher mortality rate than those who received radiotherapy (5‐year survival rate: 71.2% vs 83.8%), with multivariable‐adjusted HRs of 1.65 (95% CI: 1.57‐1.72) for 3‐year mortality, 1.53 (1.47‐1.58) for 5‐year mortality and 1.43 (1.39‐1.48) for 10‐year mortality. The association held even for patients ≥90 years. This association was observed in all strata by reasons for radiotherapy omission, receipt of endocrine therapy or chemotherapy, calendar period and other clinical characteristics, with 40% to 65% increased 5‐year mortality for patients without radiotherapy. This positive association persisted when analyses were restricted to patients with T1N0 and estrogen‐receptor‐positive disease who had received endocrine therapy (5‐year mortality: HR 1.47 [1.39‐1.57]) and in propensity score weighted analyses. Our study shows, in routine practice, elderly patients who received no post‐BCS radiotherapy had higher total mortality than those who received radiotherapy. These findings suggest that the current recommendation of omission of post‐BCS radiotherapy for elderly women with early‐stage breast cancer may need to be reconsidered, particularly for those without contraindication.