Maria Carmen De Santis1, Francesca Bonfantini2, Francesca Di Salvo3, Alba Fiorentino4, Michela Dispinzieri5, Mariangela Caputo5, Serena Di Cosimo6, Gabriella Mariani7, Massimiliano Gennaro8, Vito Cosentino2, Milena Sant3, Emanuele Pignoli2, Riccardo Valdagni9, Laura Lozza5. 1. Radiotherapy Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. Electronic address: mariacarmen.desantis@istitutotumori.mi.it. 2. Medical Physics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 3. Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 4. Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, Negrar, Verona, Italy. 5. Radiotherapy Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 6. Department of Applied Research and Technological Development (DRAST), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 7. Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 8. Breast Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 9. Radiation Oncology 1 and Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Department of Oncology and Hemato-oncology, Università degli Studi di Milano, Milan, Italy.
Abstract
PURPOSE: To examine local control, disease-free survival (DFS), and toxicity in elderly (≥ 65 years) breast cancer patients treated with hypofractionated radiotherapy (hypo-RT) with or without a boost to the tumor bed. PATIENTS AND METHODS: The study was conducted on 752 patients treated from April 2009 to February 2017. Patients received 42.4 Gy in 16 daily fractions (2.65 Gy per fraction). A boost was only administered in cases of grade 3 primary tumor and close or positive margins. Acute and late toxicity was prospectively assessed during and after hypo-RT, based on the Radiation Therapy Oncology Group scale. DFS and local recurrence-free survival were estimated by the Kaplan-Meier method for cumulative probability. Log-rank tests were used to identify differences by subtype. Cox proportional hazard models were used to investigate the impact of various factors on the risk of disease progression. RESULTS: Among the 752 patients treated, 41 (5.5%) experienced disease progression, including 7 (17.1%) exclusively local recurrences; 1 (2.4%) local and nodal recurrence; 1 (2.4%) local and nodal recurrence plus metastasis; 7 (17.1%) nodal recurrences plus metastases; and 25 (61%) exclusively distant metastases. The 5-year DFS, local recurrence-free survival, breast cancer-specific survival, and overall survival rates were 91.8% (95% confidence interval [CI], 88.6-94.2), 98.0% (95% CI, 96.1-99.1), 98.2% (95% CI, 96.5-99.1), and 87.5% (95% CI, 83.8-90.5), respectively. On univariate analysis, the administration of a boost, disease grade (grades 1 and 2 vs. 3), and molecular subtype (triple negative or human epidermal growth factor receptor 2 [HER2] positive, or luminal B vs. luminal A) significantly affected disease progression (P < .01). These findings were confirmed by multivariate analysis. CONCLUSION: Hypo-RT is effective and well tolerated in the elderly population, and the routine use of a boost for patients over 65 years is not justified. Further studies on the boost issue are strongly advocated.
PURPOSE: To examine local control, disease-free survival (DFS), and toxicity in elderly (≥ 65 years) breast cancerpatients treated with hypofractionated radiotherapy (hypo-RT) with or without a boost to the tumor bed. PATIENTS AND METHODS: The study was conducted on 752 patients treated from April 2009 to February 2017. Patients received 42.4 Gy in 16 daily fractions (2.65 Gy per fraction). A boost was only administered in cases of grade 3 primary tumor and close or positive margins. Acute and late toxicity was prospectively assessed during and after hypo-RT, based on the Radiation Therapy Oncology Group scale. DFS and local recurrence-free survival were estimated by the Kaplan-Meier method for cumulative probability. Log-rank tests were used to identify differences by subtype. Cox proportional hazard models were used to investigate the impact of various factors on the risk of disease progression. RESULTS: Among the 752 patients treated, 41 (5.5%) experienced disease progression, including 7 (17.1%) exclusively local recurrences; 1 (2.4%) local and nodal recurrence; 1 (2.4%) local and nodal recurrence plus metastasis; 7 (17.1%) nodal recurrences plus metastases; and 25 (61%) exclusively distant metastases. The 5-year DFS, local recurrence-free survival, breast cancer-specific survival, and overall survival rates were 91.8% (95% confidence interval [CI], 88.6-94.2), 98.0% (95% CI, 96.1-99.1), 98.2% (95% CI, 96.5-99.1), and 87.5% (95% CI, 83.8-90.5), respectively. On univariate analysis, the administration of a boost, disease grade (grades 1 and 2 vs. 3), and molecular subtype (triple negative or human epidermal growth factor receptor 2 [HER2] positive, or luminal B vs. luminal A) significantly affected disease progression (P < .01). These findings were confirmed by multivariate analysis. CONCLUSION: Hypo-RT is effective and well tolerated in the elderly population, and the routine use of a boost for patients over 65 years is not justified. Further studies on the boost issue are strongly advocated.
Authors: Michela Dispinzieri; Eliana La Rocca; Elisabetta Meneghini; Alba Fiorentino; Laura Lozza; Serena Di Cosimo; Massimiliano Gennaro; Vito Cosentino; Milena Sant; Emanuele Pignoli; Riccardo Valdagni; Francesca Bonfantini; Maria Carmen De Santis Journal: Med Oncol Date: 2018-06-16 Impact factor: 3.064
Authors: E La Rocca; E Meneghini; L Lozza; A Fiorentino; A Vitullo; C Giandini; F Bonfantini; S Di Cosimo; M Gennaro; M Sant; E Pignoli; R Valdagni; Maria Carmen De Santis Journal: J Cancer Res Clin Oncol Date: 2020-05-13 Impact factor: 4.553
Authors: S Dicuonzo; M C Leonardi; D P Rojas; B A Jereczek-Fossa; S Raimondi; G Corrao; V Bagnardi; M A Gerardi; A Morra; M A Zerella; M Zaffaroni; F Pansini; F Cattani; R Luraschi; C Fodor; P Veronesi; R Orecchia Journal: Clin Transl Oncol Date: 2021-02-03 Impact factor: 3.405
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
Authors: Alice Zamagni; Milly Buwenge; Ilario Ammendolia; Martina Ferioli; Anna Mandrioli; Alessio G Morganti; Silvia Cammelli Journal: Transl Cancer Res Date: 2020-01 Impact factor: 1.241