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Journal of Radiation Oncology
Published in: Journal of Radiation Oncology 3/2019

01-09-2019 | Breast Cancer | Original Research

Patterns of relapse in older women diagnosed with estrogen receptor (ER)–positive early-stage breast cancer (BC) treated with lumpectomy without adjuvant endocrine therapy (ET)

Authors: Manjeet Chadha, T. Shao, S. Cate, S. Malamud, C. White, S. K. Boolbol

Published in: Journal of Radiation Oncology | Issue 3/2019

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Abstract

Purpose

Randomized trials comparing endocrine therapy (ET) with no ET show reduced overall relapse rates with adjuvant ET for patients with early-stage estrogen receptor (ER)–positive breast cancer (BC). Of note, these studies include few patients over the age of 65 years. Currently, with ET routinely prescribed, there is limited opportunity to study the patterns of relapse without ET. The objective of our study is to evaluate the rates of local-regional and distant relapse in older BC women who postoperatively did not receive ET.

Methods

In this retrospective study, we identified 92 patients who did not receive ET after lumpectomy in our database of 1172 patients’ age 65 years or older (median age 75 years) with ER-positive, node-negative BC. Following lumpectomy, 37 patients (40%) received radiation therapy (RT) and 55 patients (60%) were observed.

Results

Median follow-up for the entire cohort is 65.5 months, and the 5-year overall survival rate is 89.3%. The 5-year relapse-free survival rates with lumpectomy + RT and lumpectomy alone are 97% and 84%, respectively (p = 0.008). One of 37 patients treated with lumpectomy + RT developed a local recurrence (3%), and no distant relapse was observed. Among patients treated with lumpectomy alone, 8/55 (15%) had a local relapse and one patient (2%) experienced distant relapse.

Conclusion

Patterns of relapse in older women with ER-positive early-stage BC note that local relapse is the most common site of failure. In this study, we also observed a low risk of distant relapse among patients not receiving ET. These observations on relapse patterns suggest that older women with early-stage BC may derive more benefit from adjuvant RT alone and be spared the potential side effects of ET.
Literature
1.
DeSantis CE, Fedewa SA, Sauer AG et al (2016) Breast Cancer Statistics, 2015: convergence of incidence rates between Black and White women. CA Cancer J Clin 66:31–42CrossRef
2.
3.
4.
Potter R, Gnant M, Kwasny W (2007) Lumpectomy plus tamoxifen or anastrazole with or without whole breast radiation in women with favorable early breast cancer. Int J Radiat Oncol Biol Phys 68(2):334–340CrossRef
5.
Hughes KS, Schnaper LA, Bellon JR et al (2013) 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
6.
Kunkler IH, Williams LJ, Jack WJL et al (2015) Breast-conserving surgery with or without irradiation in women aged 65 years or older with early breast cancer (PRIME II): a randomized controlled trial. Lancet Oncol
7.
Fyles AW, McCready DR, Manchul LA et al (2004) Tamoxifen with or without breast irradiation in women 50 years or older with early breast cancer. N Engl J Med 351:963–970CrossRef
8.
Fisher B, Constantino J, Redmond C et al (1989) Tamoxifen treatment for breast cancer: a randomized clinical trial evaluating tamoxifen in the treatment of patients with node-negative breast cancer who have estrogen-receptor-positive tumors. N Engl J Med 320:479–484CrossRef
9.
Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) (2011) Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials. Lancet 378:771–784CrossRef
10.
Fisher B, Bryant J, Dignam JJ et al (2002) Tamoxifen, radiation therapy, or both for prevention of ipsilateral breast tumor recurrence after lumpectomy in women with invasive breast cancers of one centimeter or less. J Clin Oncol 20:4141–4149CrossRef
11.
Winzer KJ, Sauerb W, Sauerbrei W et al (2004) Radiation therapy after breast-conserving surgery: first results of a randomised clinical trial in patients with low risk of recurrence. Eur J Cancer 40:998–1005CrossRef
12.
Winzer KJ, Sauerbrei W, Braun M et al (2010) Radiation therapy and tamoxifen after breast conserving surgery: updated results of a 22 randomised clinical trial in patients with low risk of recurrence. Eur J Cancer 46:95–101CrossRef
13.
Blamey RW, Chetty U, Bates T et al (2008) Radiotherapy and/or tamoxifen after conserving surgery for breast cancers of excellent prognosis: BASO II trial. Eur J Cancer 6(suppl):55
14.
Blamey RW, Bates T, Chetty U et al (2013) Radiotherapy or tamoxifen after conserving surgery for breast cancers of excellent prognosis: British Association of Surgical Oncology (BASO) II trial. Eur J Cancer 49:2294–2302CrossRef
15.
Harris LN, Ismaila N, McShane LM et al (2016) on behalf of the American Society of Clinical Oncology. Use of biomarkers to guide decisions on adjuvant systemic therapy for women with early-stage invasive breast cancer: American Society of Clinical Oncology practice guideline. J Clin Oncol 34:1134–1150CrossRef
16.
Metadata
Title
Patterns of relapse in older women diagnosed with estrogen receptor (ER)–positive early-stage breast cancer (BC) treated with lumpectomy without adjuvant endocrine therapy (ET)
Authors
Manjeet Chadha
T. Shao
S. Cate
S. Malamud
C. White
S. K. Boolbol
Publication date
01-09-2019
Publisher
Springer Berlin Heidelberg
Published in
Journal of Radiation Oncology / Issue 3/2019
Print ISSN: 1948-7894
Electronic ISSN: 1948-7908
DOI
https://doi.org/10.1007/s13566-019-00405-y

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