Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 3/2014

01-03-2014 | Breast Oncology

Breast-Conserving Surgery With or Without Radiotherapy in Older Breast Patients With Early Stage Breast Cancer: A Systematic Review and Meta-analysis

Authors: Willemien van de Water, MD, Esther Bastiaannet, PhD, Astrid N. Scholten, MD, Mandy Kiderlen, MD, Anton J. M. de Craen, PhD, Rudi G. J. Westendorp, MD, PhD, Cornelis J. H. van de Velde, MD, PhD, Gerrit-Jan Liefers, MD, PhD

Published in: Annals of Surgical Oncology | Issue 3/2014

Login to get access

Abstract

Background

In early stage breast cancer, radiotherapy is an integral part of locoregional treatment with breast-conserving surgery. However, few older patients are included in the clinical trials upon which these recommendations are based. Therefore, we performed a systematic review and meta-analysis to evaluate outcomes of radiotherapy after breast-conserving surgery in older patients.

Methods

A systematic search of PubMed and Embase was undertaken. Inclusion was restricted to randomized controlled trials in postmenopausal breast cancer patients. Pooled odds ratios were calculated for locoregional recurrence, distant recurrence, and overall survival.

Results

We included 5 randomized clinical trials comprising 3,190 patients. Overall, 39 % of the patients were ≥70 years old, and most had hormone receptor–positive T1 tumors without nodal involvement. All patients received adjuvant systemic therapy. Patients who received radiotherapy had a lower relative risk of locoregional recurrence (pooled odds ratio [OR] 0.36; 95 % confidence interval [CI] 0.25–0.50). The 5-year absolute risk was 2.2 % (95 % CI 1.6–3.1) among patients who received radiotherapy, versus 6.5 % (95 % CI 5.3–7.9) among patients who did not. The absolute risk difference was 4.3 % (95 % CI 2.9–5.7), corresponding with a number needed to treat of 24. No differences were observed for distant recurrence or overall survival.

Conclusions

Although patients who received radiotherapy had a lower relative risk of locoregional recurrence, the absolute risk was low, and overall survival was not affected. We propose that the debate should not only focus on the relative risk but also on the absolute benefit of radiotherapy and the number needed to treat. Both treatment options may be reasonable in clinical practice.
Appendix
Available only for authorised users
Literature
1.
Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), Darby S, McGale P, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet. 2011;378(9804):1707–16.PubMedCrossRef
2.
Zulman DM, Sussman JB, Chen X, et al. Examining the evidence: a systematic review of the inclusion and analysis of older adults in randomized controlled trials. J Gen Intern Med. 2011;26:783–90.PubMedCentralPubMedCrossRef
3.
Hillner BE, Mandelblatt J. Caring for older women with breast cancer: can observational research fill the clinical trial gap? J Natl Cancer Inst. 2006;98:660–1.PubMedCrossRef
4.
van de Water W, Markopoulos C, van de Velde CJH, et al. Association between age at diagnosis and disease-specific mortality among postmenopausal women with hormone receptor–positive breast cancer. JAMA. 2012;307:590–7.PubMed
5.
Aapro M, Bernard-Marty C, Brain EGC, et al. Anthracycline cardiotoxicity in the elderly cancer patient: a SIOG expert position paper. Ann Oncol. 2011;22:257–67.PubMedCrossRef
6.
Sokol KC, Knudsen JF, Li MM. Polypharmacy in older oncology patients and the need for an interdisciplinary approach to side-effect management. J Clin Pharm Ther. 2007;32:169–75.PubMedCrossRef
7.
Yellen SB, Cella DF, Leslie WT. Age and clinical decision making in oncology patients. J Natl Cancer Inst. 1994;86:1766–70.PubMedCrossRef
8.
Keating NL, Landrum MB, Brooks JM, et al. Outcomes following local therapy for early-stage breast cancer in non-trial populations. Breast Cancer Res Treat. 2011;125:803–13.PubMedCentralPubMedCrossRef
9.
Schonberg MA, Marcantonio ER, Li D, et al. Breast cancer among the oldest old: tumor characteristics, treatment choices, and survival. J Clin Oncol. 2010;28:2038–45.PubMedCrossRef
10.
Gruenberger T, Gorlitzer M, Soliman T, et al. It is possible to omit postoperative irradiation in a highly selected group of elderly breast cancer patients. Breast Cancer Res Treat. 1998;50:37–46.PubMedCrossRef
11.
Ford HT, Coombes RC, Gazet J-C, et al. Long-term follow-up of a randomised trial designed to determine the need for irradiation following conservative surgery for the treatment of invasive breast cancer. Ann Oncol. 2006;17:401–8.PubMedCrossRef
12.
Hughes KS, Schnaper LA, Bellon JR, et al. Lumpectomy plus tamoxifen with or without irradiation in women age 70 years or older with early breast cancer: long-term follow-up of CALGB 9343. J Clin Oncol. 2013;31:2382–7.PubMedCrossRef
13.
Fyles AW, McCready DR, Manchul LA, et al. Tamoxifen with or without breast irradiation in women 50 years of age or older with early breast cancer. N Engl J Med. 2004;351:963–70.PubMedCrossRef
14.
Geiger AM, Thwin SS, Lash TL, et al. Recurrences and second primary breast cancers in older women with initial early-stage disease. Cancer. 2007;109:966–74.PubMedCrossRef
15.
Smith BD, Gross CP, Smith GL, et al. Effectiveness of radiation therapy for older women with early breast cancer. J Natl Cancer Inst. 2006;98:681–90.PubMedCrossRef
16.
Bastiaannet E, Liefers GJ, de Craen AJM, et al. Breast cancer in elderly compared to younger patients in the Netherlands: stage at diagnosis, treatment and survival in 127,805 unselected patients. Breast Cancer Res Treat. 2010;124:801–7.PubMedCrossRef
17.
Kiderlen M, Bastiaannet E, Walsh PM, et al. Surgical treatment of early stage breast cancer in elderly: an international comparison. Breast Cancer Res Treat. 2012;132:675–82.PubMedCentralPubMedCrossRef
18.
Vandenbroucke JP. When are observational studies as credible as randomised trials? Lancet. 2004;363(9422):1728–31.PubMedCrossRef
19.
Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21:1539–58.PubMedCrossRef
20.
Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–34.PubMedCrossRef
21.
Hughes KS, Schnaper LA, Berry D, et al. Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer. N Engl J Med. 2004;351:971–7.PubMedCrossRef
22.
Tinterri C, Gatzemeier W, Zanini V, et al. Conservative surgery with and without radiotherapy in elderly patients with early-stage breast cancer: a prospective randomised multicentre trial. Breast. 2009;18:373–7.PubMedCrossRef
23.
Pötter R, Gnant M, Kwasny W, et al. Lumpectomy plus tamoxifen or anastrozole with or without whole breast irradiation in women with favorable early breast cancer. Int J Radiat Oncol Biol Phys. 2007;68:334–40.PubMedCrossRef
24.
Vinh-Hung V, Verschraegen C. Breast-conserving surgery with or without radiotherapy: pooled-analysis for risks of ipsilateral breast tumor recurrence and mortality. J Natl Cancer Inst. 2004;96:115–21.PubMedCrossRef
25.
Dragun AE, Huang B, Tucker TC, Spanos WJ. Disparities in the application of adjuvant radiotherapy after breast-conserving surgery for early stage breast cancer: impact on overall survival. Cancer. 2011;117:2590–8.PubMedCrossRef
26.
Yood MU, Owusu C, Buist DSM, et al. Mortality impact of less-than-standard therapy in older breast cancer patients. J Am Coll Surg. 2008;206:66–75.PubMedCrossRef
27.
Truong PT, Bernstein V, Lesperance M, et al. Radiotherapy omission after breast-conserving surgery is associated with reduced breast cancer-specific survival in elderly women with breast cancer. Am J Surg. 2006;191:749–55.PubMedCrossRef
28.
Livi L, Paiar F, Meldolesi E, et al. The management of elderly patients with T1–T2 breast cancer treated with or without radiotherapy. Eur J Surg Oncol. 2005;31:473–8.PubMedCrossRef
29.
Fisher B, Dignam J, Bryant J, et al. Five versus more than five years of tamoxifen therapy for breast cancer patients with negative lymph nodes and estrogen receptor–positive tumors. J Natl Cancer Inst. 1996;88:1529–42.PubMedCrossRef
30.
Bellon JR, Harris EER, Arthur DW, et al. ACR Appropriateness Criteria® conservative surgery and radiation—stage I and II breast carcinoma: Expert Panel on Radiation Oncology: Breast. Breast J. 2011;17:448–55.PubMedCrossRef
31.
32.
Biganzoli L, Wildiers H, Oakman C, et al. Management of elderly patients with breast cancer: updated recommendations of the International Society of Geriatric Oncology (SIOG) and European Society of Breast Cancer Specialists (EUSOMA). Lancet Oncol. 2012;13:e148–60.PubMedCrossRef
33.
Albert JM, Liu DD, Shen Y, et al. Nomogram to predict the benefit of radiation for older patients with breast cancer treated with conservative surgery. J Clin Oncol. 2012;30:2837–43.PubMedCrossRef
Metadata
Title
Breast-Conserving Surgery With or Without Radiotherapy in Older Breast Patients With Early Stage Breast Cancer: A Systematic Review and Meta-analysis
Authors
Willemien van de Water, MD
Esther Bastiaannet, PhD
Astrid N. Scholten, MD
Mandy Kiderlen, MD
Anton J. M. de Craen, PhD
Rudi G. J. Westendorp, MD, PhD
Cornelis J. H. van de Velde, MD, PhD
Gerrit-Jan Liefers, MD, PhD
Publication date
01-03-2014
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 3/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-013-3374-y

Other articles of this Issue 3/2014

Annals of Surgical Oncology 3/2014 Go to the issue

Gastrointestinal Oncology

Prognostic Significance of Complications after Curative Surgery for Gastric Cancer

Breast Oncology

Quilting Prevents Seroma Formation Following Breast Cancer Surgery: Closing the Dead Space by Quilting Prevents Seroma Following Axillary Lymph Node Dissection and Mastectomy

Breast Oncology

Reducing Persistent Postoperative Pain and Disability 1 Year After Breast Cancer Surgery: A Randomized, Controlled Trial Comparing Thoracic Paravertebral Block to Local Anesthetic Infiltration

Gastrointestinal Oncology

Morbidity Associated with Colostomy Reversal After Cytoreductive Surgery and HIPEC

Urologic Oncology

MicroRNAs with Prognostic Potential for Metastasis in Clear Cell Renal Cell Carcinoma: A Comparison of Primary Tumors and Distant Metastases

Colorectal Cancer

An MRI-based Assessment of Standard and Extralevator Abdominoperineal Excision Specimens: Time for a Patient Tailored Approach?