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Breast conservation safe in patients with T3 breast cancer tumors
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Breast conservation therapy appeared safe among Medicare patients with T3 primary breast cancer tumors, according to results of a retrospective study.
Patients who underwent breast conservation therapy achieved OS and disease-specific survival rates comparable to those who underwent mastectomy, results showed.
Richard J. Bleicher
“[Breast conservation therapy] may remain an option for patients with larger tumors when deemed clinically and cosmetically amenable to surgical resection,” Richard J. Bleicher, MD, of the department of surgical oncology at Fox Chase Cancer Center, and colleagues wrote.
The researchers used the SEER database to collect data on 5,685 Medicare recipients aged 66 years and older with breast tumors 5 cm or larger.
The investigators identified women who underwent surgery for invasive, noninflammatory, nonmetastatic breast cancer between 1992 and 2009, of whom 887 received breast conservation therapy.
The researchers adjusted for demographic characteristics, as well as tumor and treatment factors.
Median follow-up was 7 years.
Several factors predicted breast conservation therapy receipt. They included neoadjuvant chemotherapy and postoperative radiotherapy use, higher income, breast cancer as a first malignancy, history of a previous non-breast malignancy, and a higher Charlson Comorbidity Index.
Neoadjuvant chemotherapy served as the strongest coefficient predictor of breast conservation therapy (OR = 3.4; 95% CI, 2.46-4.7).
Researchers reported an increase over time in the use of breast conservation therapy for patients with tumors larger than 5 cm (OR = 1.02 per year; 95% CI, 1.01-1.04). Use increased from 10.4% to 18.6% during the study period.
Mastectomy appeared associated with the following predictors: younger age, Asian race, lobular/other nonductal histology, higher tumor grade, numbers of examined and affected lymph nodes, American Joint Committee on Cancer (AJCC) Stage III disease, postoperative chemotherapy treatment and geographic region of residence.
The strongest coefficient predictor of mastectomy as a treatment selection was AJCC Stage III disease (OR = 0.39; 95% CI, 0.31-0.48).
The researchers found no difference in adjusted OS or disease-specific survival between patients who underwent breast conservation therapy vs. mastectomy (HR = 0.93; 95% CI, 0.79-1.1 for OS; subdistribution HR = 1.04; 95% CI, 0.79-1.36 for disease-specific survival). Both measures improved over time.
The findings suggest breast conservation therapy is safe for women with tumors larger than 5 cm, and that this surgical option is increasingly offered to women for whom it was previously contraindicated.
“Although a prospective trial would be ideal, we do not anticipate resources to be allocated to another such trial,” Bleicher and colleagues wrote. “Therefore, we recommend that tumor size no longer be considered a relative contraindication in this subgroup of patients when breast size can accommodate such a resection.” – by Jennifer Byrne
Disclosure: The researchers report no relevant disclosures.
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