Department of Radiation Oncology, Dalhousie University, 5820 University Avenue, Halifax, NS, B3H 1V7, Canada.
Cancer Registry & Analytics Unit, NSHA Cancer Care Program, QEII Health Sciences Centre, Room 556, Bethune Building, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada.
Breast Cancer Res Treat. 2020 Jul;182(2):411-420. doi: 10.1007/s10549-020-05691-6. Epub 2020 May 21.
Women over 70 with early breast cancer treated with breast-conserving surgery are typically offered adjuvant endocrine and radiation therapy. Prior studies have supported the omission of adjuvant radiation in this low-risk population. We sought to compare the effect of adjuvant treatment with endocrine therapy alone, radiation therapy alone or both versus no adjuvant treatment on local control and survival in this population.
Data were extracted on 1363 breast cancer patients over the age of 70 treated with a breast-conserving surgery from 2003 until 2018. 460 patients met inclusion criteria of pT1N0, invasive disease with negative margins and not treated with chemotherapy. The primary outcome of this population-based study was local recurrence-free survival at 5 and 10 years.
Patients receiving no adjuvant therapy had worse local recurrence-free, loco-regional recurrence-free and disease-free survival than patients receiving at least one form of adjuvant therapy (p < 0.05). 5-year local recurrence rates were 0.8% in patients receiving both endocrine and radiation therapy, 1.5% in those receiving radiation alone, 4.2% in those receiving endocrine therapy alone and 12% in those receiving no adjuvant therapy.
This study supports the benefit of some form of adjuvant therapy (radiation alone, endocrine therapy alone or both) in low-risk breast cancer patients over 70. Receiving no adjuvant therapy is associated with poorer outcomes. Many of these patients are candidates for Accelerated Partial Breast Irradiation which can be completed in less than a week. These patients should be offered radiation therapy, endocrine therapy or both.
接受保乳手术治疗的 70 岁以上早期乳腺癌女性通常会接受辅助内分泌治疗和放疗。先前的研究支持在这种低危人群中省略辅助放疗。我们旨在比较在该人群中，与不接受辅助治疗相比，单独接受内分泌治疗、单独接受放疗或两者联合治疗对局部控制和生存的影响。
从 2003 年到 2018 年，我们对 1363 名年龄在 70 岁以上接受保乳手术的乳腺癌患者进行了数据分析。460 名患者符合纳入标准，即 pT1N0、浸润性疾病且切缘阴性，未接受化疗。这项基于人群的研究的主要结局是 5 年和 10 年的局部无复发生存率。
与接受至少一种辅助治疗的患者相比，未接受辅助治疗的患者局部无复发生存率、局部区域无复发生存率和无病生存率更差（p<0.05）。接受内分泌联合放疗的患者 5 年局部复发率为 0.8%，单独接受放疗的患者为 1.5%，单独接受内分泌治疗的患者为 4.2%，未接受辅助治疗的患者为 12%。
这项研究支持在 70 岁以上低危乳腺癌患者中采用某种形式的辅助治疗（单独放疗、单独内分泌治疗或两者联合）的益处。不接受辅助治疗与较差的结局相关。这些患者中有许多适合接受加速部分乳腺照射，这种治疗可以在不到一周的时间内完成。应向这些患者提供放疗、内分泌治疗或两者联合治疗。
