Breast-conserving surgery without radiation in elderly women with early breast cancer

• Published in: Surgical oncology Vol. 31; pp. 22 - 25
• Main Authors: Inoue, Hiroaki, Hirano, Akira, Ogura, Kaoru, Kamimura, Mari, Hattori, Akinori, Yukawa, Hiroko, Sakaguchi, Shiho, Tanaka, Natsuko, Matsuoka, Aya, Kodera, Asaka, Shimizu, Tadao
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.12.2019; Elsevier Limited
• Subjects: Age; Aged; Aged, 80 and over; Background radiation; Breast cancer; Breast Neoplasms - pathology; Breast Neoplasms - radiotherapy; Breast Neoplasms - surgery; Breast-conserving surgery; Cancer therapies; Carcinoma, Ductal, Breast - pathology; Carcinoma, Ductal, Breast - radiotherapy; Carcinoma, Ductal, Breast - surgery; Chemotherapy; Combined Modality Therapy; Criteria; Early breast cancer; Elderly woman; Endocrine therapy; Female; Follow-Up Studies; Geriatrics; Humans; Irradiation; Mastectomy; Mastectomy, Segmental - mortality; Medical prognosis; Metastasis; Middle Aged; Neoplasm Invasiveness; Older people; Patients; Prognosis; Radiation; Radiation therapy; Radiotherapy, Adjuvant - mortality; Retrospective Studies; Studies; Surgery; Survival; Survival Rate; Tumors; Women; Early breast cancer; Elderly woman; Breast-conserving surgery
• ISSN: 0960-7404; 1879-3320
• DOI: 10.1016/j.suronc.2019.08.008

Irradiation after breast-conserving surgery (BCS) decreases the incidence of ipsilateral breast tumor recurrence (IBTR) and breast cancer-related death. However, daily radiation treatments are burdensome to elderly patients, whose risk of IBTR is relatively low. Since 2001, we have offered BCS without radiation to patients meeting our selection criteria. This study assessed the prognosis of the patients who chose this option. Between 2001 and 2014, 203 patients met the selection criteria: aged ≥60 years; pathologically node-negative, hormone-positive breast cancer; a negative surgical margin; and no lymphovascular invasion. Among these patients, 84 and 119 underwent BCS with or without radiation, respectively. IBTR, overall survival (OS), and breast cancer-specific survival (BCSS) were evaluated. The median follow-up duration was 6.2 years. There were no significant differences in tumor size or the number of patients with adjuvant therapy between the groups. The 5-year IBTR rates were 0.9% and 1.6% in the non-irradiated and irradiated groups, respectively (p = 0.308). The 5-year OS rates were 94.1% and 98.7% (p = 0.391). Similarly, the 5-year BCSS rates were 97.2% and 98.7% (p = 0.812). It is suggested that the omission of irradiation could be an option for elderly breast cancer patients who satisfy our criteria. •Beast conserving surgery (BCS) without radiation (RT) to patients meeting our criteria.•Aged ≥60 years; n(−), ER(+); negative surgical margin, no lymphovascular invasion.•The 5-year IBTR rates were 0.9% and 1.6% in the non-irradiated and irradiated groups.•The 5-year OS and BCSS rates were approximately equal in two groups.•BCS without RT could be an option for elderly patients who satisfy our criteria. It is suggested that the omission of irradiation could be an option for elderly breast cancer patients who satisfy our selection criteria (aged ≥60 years; node-negative, hormone-positive; negative surgical margin, and no lymphovascular invasion.)