Local Control, Toxicity, and Cosmesis in Women >70 Years Enrolled in the American Society of Breast Surgeons Accelerated Partial Breast Irradiation Registry Trial

• Published in: International journal of radiation oncology, biology, physics Vol. 84; no. 2; pp. 323 - 330
• Main Authors: Khan, Atif J., M.D, Vicini, Frank A., M.D, Beitsch, Peter, M.D, Goyal, Sharad, M.D, Kuerer, Henry M., M.D, Keisch, Martin, M.D, Quiet, Coral, M.D, Zannis, Victor, M.D, Keleher, Angela, M.D, Snyder, Howard, M.D, Gittleman, Mark, M.D, Whitworth, Pat, M.D, Fine, Richard, M.D, Lyden, Maureen, M.D, Haffty, Bruce G., M.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2012; Elsevier
• Subjects: Adjuvants; Adult; Age; Age Factors; Aged; Aged, 80 and over; Antineoplastic Agents, Hormonal - therapeutic use; Biological and medical sciences; BRACHYTHERAPY; Brachytherapy - adverse effects; Brachytherapy - instrumentation; Brachytherapy - methods; Breast - blood supply; Breast cancer; Breast Neoplasms - epidemiology; Breast Neoplasms - pathology; Breast Neoplasms - radiotherapy; Clinical trials; Disease-Free Survival; ELDERLY PEOPLE; Esthetics; ESTROGENS; FAILURES; Female; Gynecology. Andrology. Obstetrics; Hematology, Oncology and Palliative Medicine; Humans; IRRADIATION; Mammary gland diseases; MAMMARY GLANDS; MammoSite; Medical sciences; Middle Aged; Neoplasm Recurrence, Local - epidemiology; NEOPLASMS; Neoplasms, Second Primary; Partial breast irradiation; PATIENTS; Radiation; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; Radiotherapy; RECEPTORS; Registries; Survival; Telangiectasis - etiology; TOXICITY; Tumor Burden; Tumors; United States; WOMEN; United States; North America; America; MammoSite; Partial breast irradiation; Breast cancer; Human; Breast disease; Toxicity; Malignant tumor; Surgeon; Mammary gland diseases; Cancerology; Partial; Register; Irradiation; Breast; Adult; Clinical trial; Female; Mammary gland; Woman; Cancer
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2011.12.027

Purpose The American Society of Breast Surgeons enrolled women in a registry trial to prospectively study patients treated with the MammoSite Radiation Therapy System breast brachytherapy device. The present report examined the outcomes in women aged >70 years enrolled in the trial. Methods and Materials A total of 1,449 primary early stage breast cancers were treated in 1,440 women. Of these, 537 occurred in women >70 years old. Fisher’s exact test was performed to correlate age (≤70 vs. >70 years) with toxicity and with cosmesis. The association of age with local recurrence (LR) failure times was investigated by fitting a parametric model. Results Older women were less likely to develop telangiectasias than younger women (7.9% vs. 12.4%, p = 0.0083). The incidence of other toxicities was similar. Cosmesis was good or excellent in 92% of the women >70 years old. No significant difference was found in LR as a function of age. The 5-year actuarial LR rate with invasive disease for the older vs. younger population was 2.79% and 2.92%, respectively ( p = 0.5780). In women >70 years with hormone-sensitive tumors ≤2 cm who received hormonal therapy ( n = 195), the 5-year actuarial rate of LR, overall survival, disease-free survival, and cause-specific survival was 2.06%, 89.3%, 87%, and 97.5%, respectively. These outcomes were similar in women who did not receive hormonal therapy. Women with small, estrogen receptor-negative disease had worse LR, overall survival, and disease-free survival compared with receptor-positive patients. Conclusions Accelerated partial breast irradiation with the MammoSite radiation therapy system resulted in low toxicity and produced similar cosmesis and local control at 5 years in women >70 years compared with younger women. This treatment should be considered as an alternative to omitting adjuvant radiotherapy for older women with small-volume, early-stage breast cancer.