BACKGROUND: For patients with breast cancer undergoing breast-conserving surgery (BCS), adjuvant radiation (RT) and hormonal therapy (HT) reduce the risk of locoregional recurrence (LRR). Although several studies have evaluated adjuvant HT ± RT, the outcomes of HT versus RT monotherapy remain less clear. In this study, the risk of LRR is characterized among older patients with early-stage breast cancer following adjuvant RT alone, HT alone, neither, or both. METHODS: This study included female patients from the Memorial Sloan Kettering Cancer Center (New York, New York) who were aged ≥65 years with estrogen receptor-positive (ER+)/human epidermal growth factor receptor 2-negative (HER2-) T1N0 breast cancer treated with BCS. The primary endpoint was time to LRR evaluated by Cox regression analysis. RESULTS: There were 888 women evaluated with a median age of 71 years (range, 65-100 years) and median follow-up of 4.9 years (range, 0.0-9.5 years). There were 27 LRR events (3.0%). Five-year LRR was 11% for those receiving no adjuvant treatment, 3% for HT alone, 4% for RT alone, and 1% for HT and RT. LRR rates were significantly different between the groups (P < .001). Compared with neither HT nor RT, HT or RT monotherapy each yielded similar LRR reductions: HT alone (HR, 0.27; 95% CI, 0.10-0.68; P = .006) and RT alone (HR, 0.32; 95% CI, 0.11-0.92; P = .034). Distant recurrence and breast cancer-specific survival rates did not significantly differ between groups. CONCLUSIONS: LRR risk following BCS is low among women aged ≥65 years with T1N0, ER+/HER2- breast cancer. Adjuvant RT and HT monotherapy each similarly reduce this risk; the combination yields a marginal improvement. Further study is needed to elucidate whether appropriate patients may feasibly receive adjuvant RT monotherapy versus the current standards of HT monotherapy or combined RT/HT.
BACKGROUND: For patients with breast cancer undergoing breast-conserving surgery (BCS), adjuvant radiation (RT) and hormonal therapy (HT) reduce the risk of locoregional recurrence (LRR). Although several studies have evaluated adjuvant HT ± RT, the outcomes of HT versus RT monotherapy remain less clear. In this study, the risk of LRR is characterized among older patients with early-stage breast cancer following adjuvant RT alone, HT alone, neither, or both. METHODS: This study included female patients from the Memorial Sloan Kettering Cancer Center (New York, New York) who were aged ≥65 years with estrogen receptor-positive (ER+)/human epidermal growth factor receptor 2-negative (HER2-) T1N0 breast cancer treated with BCS. The primary endpoint was time to LRR evaluated by Cox regression analysis. RESULTS: There were 888 women evaluated with a median age of 71 years (range, 65-100 years) and median follow-up of 4.9 years (range, 0.0-9.5 years). There were 27 LRR events (3.0%). Five-year LRR was 11% for those receiving no adjuvant treatment, 3% for HT alone, 4% for RT alone, and 1% for HT and RT. LRR rates were significantly different between the groups (P < .001). Compared with neither HT nor RT, HT or RT monotherapy each yielded similar LRR reductions: HT alone (HR, 0.27; 95% CI, 0.10-0.68; P = .006) and RT alone (HR, 0.32; 95% CI, 0.11-0.92; P = .034). Distant recurrence and breast cancer-specific survival rates did not significantly differ between groups. CONCLUSIONS: LRR risk following BCS is low among women aged ≥65 years with T1N0, ER+/HER2- breast cancer. Adjuvant RT and HT monotherapy each similarly reduce this risk; the combination yields a marginal improvement. Further study is needed to elucidate whether appropriate patients may feasibly receive adjuvant RT monotherapy versus the current standards of HT monotherapy or combined RT/HT.
Authors: K-J Winzer; R Sauer; W Sauerbrei; E Schneller; W Jaeger; M Braun; J Dunst; T Liersch; M Zedelius; K Brunnert; H Guski; C Schmoor; M Schumacher Journal: Eur J Cancer Date: 2004-05 Impact factor: 9.162
Authors: M Clarke; R Collins; S Darby; C Davies; P Elphinstone; V Evans; J Godwin; R Gray; C Hicks; S James; E MacKinnon; P McGale; T McHugh; R Peto; C Taylor; Y Wang Journal: Lancet Date: 2005-12-17 Impact factor: 79.321
Authors: Colin T Murphy; Tianyu Li; Lora S Wang; Elias I Obeid; Richard J Bleicher; Gary Eastwick; Matthew E Johnson; Shelly B Hayes; Stephanie E Weiss; Penny R Anderson Journal: Clin Breast Cancer Date: 2015-03-02 Impact factor: 3.225
Authors: Bernard Fisher; John Bryant; James J Dignam; D Lawrence Wickerham; Eleftherios P Mamounas; Edwin R Fisher; Richard G Margolese; Lois Nesbitt; Soonmyung Paik; Thomas M Pisansky; Norman Wolmark Journal: J Clin Oncol Date: 2002-10-15 Impact factor: 44.544
Authors: U Veronesi; A Luini; M Del Vecchio; M Greco; V Galimberti; M Merson; F Rilke; V Sacchini; R Saccozzi; T Savio Journal: N Engl J Med Date: 1993-06-03 Impact factor: 91.245
Authors: Kevin S Hughes; Lauren A Schnaper; Jennifer R Bellon; Constance T Cirrincione; Donald A Berry; Beryl McCormick; Hyman B Muss; Barbara L Smith; Clifford A Hudis; Eric P Winer; William C Wood Journal: J Clin Oncol Date: 2013-05-20 Impact factor: 44.544
Authors: Meredith M Regan; Prudence A Francis; Olivia Pagani; Gini F Fleming; Barbara A Walley; Giuseppe Viale; Marco Colleoni; István Láng; Henry L Gómez; Carlo Tondini; Graziella Pinotti; Karen N Price; Alan S Coates; Aron Goldhirsch; Richard D Gelber Journal: J Clin Oncol Date: 2016-04-04 Impact factor: 44.544
Authors: Adrian Murray Brunt; Joanne S Haviland; Duncan A Wheatley; Mark A Sydenham; Abdulla Alhasso; David J Bloomfield; Charlie Chan; Mark Churn; Susan Cleator; Charlotte E Coles; Andrew Goodman; Adrian Harnett; Penelope Hopwood; Anna M Kirby; Cliona C Kirwan; Carolyn Morris; Zohal Nabi; Elinor Sawyer; Navita Somaiah; Liba Stones; Isabel Syndikus; Judith M Bliss; John R Yarnold Journal: Lancet Date: 2020-04-28 Impact factor: 202.731