Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Ann Surg Oncol. 2019 Apr;26(4):969-975. doi: 10.1245/s10434-018-07151-4. Epub 2019 Feb 8.
Despite data from randomized trials supporting omission of radiation therapy (RT) for women ≥ 70 years of age with T1, estrogen receptor-positive (ER+) tumors undergoing breast-conserving therapy (BCT), RT usage remains high. We reviewed our institutional experience to determine if risk factors for local recurrence or comorbidities influenced use.
Women ≥ 70 years of age with T1, ER+, human epidermal growth factor receptor 2-negative (HER2-) tumors undergoing BCT in 2010-2012 were identified from a prospectively maintained database. Ten-year estimated mortality was calculated using the Suemoto index. The associations of clinicopathological features and mortality risk on receipt of RT were examined.
Overall, 323 patients with 327 cancers were identified. Median age was 75 years, median tumor size was 1 cm, and all were clinically node negative; 53.7% of patients received RT. RT usage decreased with age (73.6%, age 70-74 years; 49.5%, age 75-79 years; 33.3%, age 80-84 years; 10.7%, ≥ 85 years; p < 0.001). Within age groups, estimated mortality did not impact RT usage. On multivariable analysis, only younger age and larger tumor size were associated with RT use. Recurrence-free survival was 98% versus 93% with and without RT, respectively (p = 0.011). Those who received adjuvant radiation also had improved overall survival (92% vs. 89%), although this effect did not reach statistical significance (p = 0.051).
Neither the factors associated with risk of local recurrence nor the estimated risk of death in 10 years were associated with use of adjuvant radiation in a large cohort of women ≥ 70 years of age with small ER+ breast cancers treated with breast-conserving surgery.
尽管随机试验数据支持对行保乳治疗（BCT）的 T1 期、雌激素受体阳性（ER+）肿瘤且年龄≥70 岁的女性免除放疗（RT），但 RT 的应用仍然很高。我们回顾了机构经验，以确定局部复发风险因素或合并症是否会影响 RT 的应用。
从前瞻性维护的数据库中确定了 2010-2012 年期间行 BCT 的 T1 期、ER+、人表皮生长因子受体 2 阴性（HER2-）肿瘤且年龄≥70 岁的女性患者。使用 Suemoto 指数计算 10 年估计死亡率。检查了临床病理特征和死亡率风险与 RT 接受之间的关联。
共有 323 例患者（327 个肿瘤）被确定。中位年龄为 75 岁，中位肿瘤大小为 1cm，且所有患者均为临床淋巴结阴性；53.7%的患者接受了 RT。RT 的应用随着年龄的增长而减少（73.6%，年龄 70-74 岁；49.5%，年龄 75-79 岁；33.3%，年龄 80-84 岁；10.7%，≥85 岁；p<0.001）。在各年龄组中，估计死亡率并不影响 RT 的应用。多变量分析显示，仅年龄较小和肿瘤较大与 RT 的应用相关。无 RT 组和有 RT 组的无复发生存率分别为 98%和 93%（p=0.011）。接受辅助放疗的患者总生存率也有所提高（92% vs. 89%），尽管这一效果尚未达到统计学意义（p=0.051）。
在一个大型队列中，与小的 ER+乳腺癌行保乳手术后，与局部复发风险相关的因素和 10 年内死亡风险的估计值均与≥70 岁女性接受辅助放疗无关。
