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Adjuvant radiation use persists among elderly women with stage I, ER-positive breast cancer
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Despite recommendations for the omission of adjuvant radiation therapy among elderly women with stage I, ER-positive breast cancer, its use only decreased approximately 3% since 2004, according to an analysis of the National Cancer Data Base.
Results of the Cancer and Leukemia Group B (CALGB) 9343 phase 3 trial — published in 2004 — showed postoperative radiation therapy could safely be omitted for women aged 70 years or older with small ER-positive tumors who underwent breast-conserving therapy and adjuvant tamoxifen.
Quyen D. Chu, MD, MBA, FACS
Based on these data, the National Comprehensive Cancer Network recommended omission of radiation therapy in elderly women who met the CALGB guidelines be given serious consideration.
However, despite this recommendation, there has been minimal reduction in radiation therapy use after 2004.
“This study … provides the nation with a better awareness of breast cancer treatment options for those elderly patients who fit these criteria,” Quyen D. Chu, MD, MBA, FACS, vice-chair and professor of surgery at Louisiana State University Health Sciences Center–Shreveport, told HemOnc Today.
Chu and colleagues examined the changes in radiation therapy use before (1998 to 2004) and after (2005 to 2012) CALGB publication, as well as the clinical and sociodemographic factors associated with omission of adjuvant radiation therapy.
The researchers used the National Cancer Data Base to identify 205,860 women aged 70 years or older diagnosed with stage I, ER-positive breast cancer between 1998 and 2012 who underwent lumpectomy.
In total, 32.77% of cases omitted postoperative radiation therapy.
Before the CALGB report, 31.29% of the 102,437 cases omitted postoperative radiation. After the CALGB report, 34.25% of the 103,423 cases omitted postoperative radiation. These data equate to an absolute decrease of 2.95% in use of radiation therapy after the CALGB report (P < .0001).
“Although phase 3 clinical trials are considered the ‘gold-standard’ that clinicians depend on to practice evidence-based medicine, the degree to which they are adopted by the medical community might not be as dramatic as one might anticipate,” Chu and colleagues wrote.
Among different age groups, women aged in their 80s demonstrated the greatest decline in radiation therapy after CALGB; however, 56% of patients aged 80 to 84 years and 30% of patients aged 85 years and older continued to receive radiation therapy (P < .0001).
Results of a multivariate analysis showed independent predictors of radiation therapy omission after the CALGB publication included advanced age, treatment at an academic research program (OR = 1.18, 95% CI, 1.1-1.26), facility located in the East South Central region (OR = 1.21, 95% CI, 1.09-1.33) and living in a rural area of less than 2,500 people not adjacent to a metropolitan region.
Further, women with a comorbidity index of 2, smaller tumor size of 0.1 to 0.5 cm (OR = 1.29, 95% CI, 1.21-1.36), well-differentiated histology, positive surgical margins and who did not receive antihormonal therapy (OR = 2.25, 95% CI, 2.16-2.34) appeared significantly less likely to undergo radiation.
Specific socioeconomic factors, such as insurance status and education level, had no influence on the use of radiation therapy.
“Whether radiation therapy should be omitted in this select group of breast cancer patients, especially among extremely elderly women, will require analysis of a large population-based database,” Chu and colleagues wrote. “Such analysis will help answer the question of whether or not results of randomized controlled trials such as CALGB and PRIME II are also observed in the general population.”– by Kristie L. Kahl
For more information:
Quyen D. Chu, MD, MBA, FACS, can be reached at qchu@lsuhsc.edu.
Disclosure: The researchers report no relevant financial disclosures.
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