BACKGROUND: The Cancer and Leukemia Group B (CALGB) 9343 randomized phase 3 trial established lumpectomy and adjuvant therapy with tamoxifen alone, rather than both radiotherapy and tamoxifen, as a reasonable treatment course for women aged >70 years with clinical stage I (AJCC 7th edition), estrogen receptor-positive breast cancer. An analysis of the Surveillance, Epidemiology, and End Results (SEER) registry was undertaken to assess practice patterns before and after the publication of this landmark study. METHODS: The SEER database from 2000 to 2009 was used to identify 40,583 women aged ≥70 years who were treated with breast-conserving surgery for clinical stage I, estrogen receptor-positive and/or progesterone receptor-positive breast cancer. The percentage of patients receiving radiotherapy and the type of radiotherapy delivered was assessed over time. Administration of radiotherapy was further assessed across age groups; SEER cohort; and tumor size, grade, and laterality. RESULTS: Approximately 68.6% of patients treated between 2000 and 2004 compared with 61.7% of patients who were treated between 2005 and 2009 received some form of adjuvant radiotherapy (P < .001). Coinciding with a decline in the use of external beam radiotherapy, there was an increase in the use of implant radiotherapy from 1.4% between 2000 and 2004 to 6.2% between 2005 to 2009 (P < .001). There were significant reductions in the frequency of radiotherapy delivery over time across age groups, tumor size, and tumor grade and regardless of laterality (P < .001 for all). CONCLUSIONS: Randomized phase 3 data support the omission of adjuvant radiotherapy in elderly women with early-stage breast cancer. Analysis of practice patterns before and after the publication of these data indicates a significant decline in radiotherapy use; however, nearly two-thirds of women continue to receive adjuvant radiotherapy.
BACKGROUND: The Cancer and Leukemia Group B (CALGB) 9343 randomized phase 3 trial established lumpectomy and adjuvant therapy with tamoxifen alone, rather than both radiotherapy and tamoxifen, as a reasonable treatment course for women aged >70 years with clinical stage I (AJCC 7th edition), estrogen receptor-positive breast cancer. An analysis of the Surveillance, Epidemiology, and End Results (SEER) registry was undertaken to assess practice patterns before and after the publication of this landmark study. METHODS: The SEER database from 2000 to 2009 was used to identify 40,583 women aged ≥70 years who were treated with breast-conserving surgery for clinical stage I, estrogen receptor-positive and/or progesterone receptor-positive breast cancer. The percentage of patients receiving radiotherapy and the type of radiotherapy delivered was assessed over time. Administration of radiotherapy was further assessed across age groups; SEER cohort; and tumor size, grade, and laterality. RESULTS: Approximately 68.6% of patients treated between 2000 and 2004 compared with 61.7% of patients who were treated between 2005 and 2009 received some form of adjuvant radiotherapy (P < .001). Coinciding with a decline in the use of external beam radiotherapy, there was an increase in the use of implant radiotherapy from 1.4% between 2000 and 2004 to 6.2% between 2005 to 2009 (P < .001). There were significant reductions in the frequency of radiotherapy delivery over time across age groups, tumor size, and tumor grade and regardless of laterality (P < .001 for all). CONCLUSIONS: Randomized phase 3 data support the omission of adjuvant radiotherapy in elderly women with early-stage breast cancer. Analysis of practice patterns before and after the publication of these data indicates a significant decline in radiotherapy use; however, nearly two-thirds of women continue to receive adjuvant radiotherapy.
Authors: Elizabeth M Jaffee; Chi Van Dang; David B Agus; Brian M Alexander; Kenneth C Anderson; Alan Ashworth; Anna D Barker; Roshan Bastani; Sangeeta Bhatia; Jeffrey A Bluestone; Otis Brawley; Atul J Butte; Daniel G Coit; Nancy E Davidson; Mark Davis; Ronald A DePinho; Robert B Diasio; Giulio Draetta; A Lindsay Frazier; Andrew Futreal; Sam S Gambhir; Patricia A Ganz; Levi Garraway; Stanton Gerson; Sumit Gupta; James Heath; Ruth I Hoffman; Cliff Hudis; Chanita Hughes-Halbert; Ramy Ibrahim; Hossein Jadvar; Brian Kavanagh; Rick Kittles; Quynh-Thu Le; Scott M Lippman; David Mankoff; Elaine R Mardis; Deborah K Mayer; Kelly McMasters; Neal J Meropol; Beverly Mitchell; Peter Naredi; Dean Ornish; Timothy M Pawlik; Jeffrey Peppercorn; Martin G Pomper; Derek Raghavan; Christine Ritchie; Sally W Schwarz; Richard Sullivan; Richard Wahl; Jedd D Wolchok; Sandra L Wong; Alfred Yung Journal: Lancet Oncol Date: 2017-10-31 Impact factor: 41.316
Authors: Rachel A Greenup; Rachel C Blitzblau; Kevin L Houck; Julie Ann Sosa; Janet Horton; Jeffrey M Peppercorn; Alphonse G Taghian; Barbara L Smith; E Shelley Hwang Journal: J Oncol Pract Date: 2017-03-14 Impact factor: 3.840
Authors: Lauren J Taylor; Jennifer S Steiman; Bethany Anderson; Jessica R Schumacher; Lee G Wilke; Caprice C Greenberg; Heather B Neuman Journal: Breast Cancer Res Treat Date: 2020-03-03 Impact factor: 4.872
Authors: Joshua R Niska; Sameer R Keole; Barbara A Pockaj; Michele Y Halyard; Samir H Patel; Donald W Northfelt; Richard J Gray; Nabil Wasif; Carlos E Vargas; William W Wong Journal: Breast Cancer (Dove Med Press) Date: 2018-02-09
Authors: Nam P Nguyen; Ulf Karlsson; Eromosele Oboite; Julio Alvarenga; Juan Godinez; Alice Zamagni; Micaela Motta; Satya Bose; Vincent Vinh-Hung Journal: Transl Cancer Res Date: 2020-01 Impact factor: 1.241