Long-term oncological outcomes of organ-sparing treatment of patients with early breast cancer aged 65 years and older who had no postoperative radiation therapy
https://doi.org/10.17650/1994-4098-2022-18-3-24-28
Abstract
Postoperative radiation therapy after breast-conserving surgery is a standard method of treating breast cancer, but recently the issue of its de-escalation in patients older than 65 due to concomitant pathology, lower life expectancy and possible development of post-radiation complications has been discussed. The results of some foreign studies prove the absence of a statistically significant difference in relapse-free and overall survival in patients with early breast cancer older than 65 years with relatively favorable clinical and morphological characteristics without postoperative radiation therapy. We analyzed the long-term oncological results in patients with breast cancer older than 65 years after breast-conserving surgery without postoperative radiation therapy. The results of the study showed that postoperative radiation therapy in patients over 65 years of age with stage IA pT1N0M0 breast cancer of luminal immunophenotype A does not improve long-term oncological indicators. Thus, the exclusion of postoperative radiation therapy from the treatment plan of this group of patients is oncologically safe and economically justified.
About the Authors
D. R. OrtabaevaRussian Federation
3 2nd Botkinskiy Proezd, Moscow 125284
A. D. Zikiryakhodzhaev
Russian Federation
3 2nd Botkinskiy Proezd, Moscow 125284
Build. 2, 8 Trubetskaya St., Moscow 119991
8 Miklukho-Maklaya St., Moscow 117198
E. A. Rasskazova
Russian Federation
Elena Aleksandrovna Rasskazova
3 2nd Botkinskiy Proezd, Moscow 125284
E. K. Saribekyan
Russian Federation
3 2nd Botkinskiy Proezd, Moscow 125284
A. D. Kaprin
Russian Federation
3 2nd Botkinskiy Proezd, Moscow 125284
8 Miklukho-Maklaya St., Moscow 117198
References
1. Fisher B., Anderson S., Bryant J. 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 2002;347(16):1233–41. DOI: 10.1056/NEJMoa022152
2. Fyles A.W., McCready D.R., Manchul L.A. et al. Tamoxifen with or without breast irradiation in women 50 years of age or older with early breast cancer. N Engl J Med 2004;351(10):963–70. DOI: 10.1056/NEJMoa040595
3. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), Darby S., McGale P. et al. Effect of radiotherapy after breastconserving 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 2011;378(9804):1707–16. DOI: 10.1016/S0140-6736(11)61629-2
4. Whelan T.J., Olivotto I.A., Parulekar W.R. et al. Regional nodal irradiation in early-stage breast cancer. N Engl J Med 2015;373(4):307–16.
5. Hughes K.S., Schnaper L.A., Bellon J.R. et al. Lumpectomy plus tamoxifen with or without irradiation in women age 70 years or older with early breast cancer: long-term follow-up of CALGB 9343. J Clin Oncol 2013;31(19):2382–7. DOI: 10.1200/JCO.2012.45.2615
6. Hughes K.S., Schnaper L.A., Berry D. et al. Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer. N Engl J Med 2004;351(10):971–7. DOI: 10.1056/NEJMoa040587
7. Arvold N.D., Taghian A.G., Niemierko A. et al. Age, breast cancer subtype approximation, and local recurrence after breastconserving therapy. J Clin Oncol 2011;29(29):3885–91.
8. Miles R.C., Gullerud R.E., Lohse C.M. et al. Local recurrence after breast-conserving surgery: multivariable analysis of risk factors and the impact of young age. Ann Surg Oncol 2012;19(4):1153–9.
9. Canavan J., Truong P.T., Smith S.L. et al. Local recurrence in women with stage I breast cancer: declining rates over time in a large, population-based cohort. Int J Radiat Oncol Biol Phys 2014;88(1):80–6.
10. Smith S.L., Truong P.T., Lu L. et al. Identification of patients at very low risk of local recurrence after breast-conserving surgery. Int J Radiat Oncol Biol Phys 2014;89(3):556–62.
11. Perou C.M., Sorlie T., Eisen M.B. et al. Molecular portraits of human breast tumours. Nature 2000;406(6797):747–52.
12. Sorlie T., Perou C.M., Tibshirani R. et al. Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci USA 2001;98(19):10869–74. DOI: 10.1073/pnas.191367098
13. Sorlie T., Tibshirani R., Parker J. et al. Repeated observation of breast tumor subtypes in independent gene expression data sets. Proc Natl Acad Sci USA 2003;100(14):8418–23.
14. Fan C., Oh D.S., Wessels L. et al. Concordance among geneexpression-based predictors for breast cancer. N Engl J Med 2006;355(6):560–9. DOI: 10.1093/annonc/mds080
15. Nguyen P.L., Taghian A.G., Katz M.S. et al. Breast cancer subtype approximated by estrogen receptor, progesterone receptor, and HER-2 is associated with local and distant recurrence after breastconserving therapy. J Clin Oncol 2008;26(14):2373–8. DOI: 10.1200/JCO.2007.14.4287
16. Voduc K.D., Cheang M.C., Tyldesley S. et al. Breast cancer subtypes and the risk of local and regional relapse. J Clin Oncol 2010;28(10):1684–91. DOI: 10.1200/JCO.2009.24.9284
Review
For citations:
Ortabaeva D.R., Zikiryakhodzhaev A.D., Rasskazova E.A., Saribekyan E.K., Kaprin A.D. Long-term oncological outcomes of organ-sparing treatment of patients with early breast cancer aged 65 years and older who had no postoperative radiation therapy. Tumors of female reproductive system. 2022;18(3):24-28. (In Russ.) https://doi.org/10.17650/1994-4098-2022-18-3-24-28