Abstract:
BACKGROUND:Two large randomized trials, CALGB 9343 and PRIME II, support omission of radiotherapy after breast conserving surgery (BCS) in elderly women with favorable-risk early stage breast cancer intending to take endocrine therapy. However, patients with grade 3 histology were underrepresented on these trials. We hypothesized that high-grade disease may be unsuitable for treatment de-escalation and report the oncologic outcomes for elderly women with favorable early stage breast cancer treated with BCS with or without radiotherapy. MATERIALS AND METHODS:The Surveillance, Epidemiology, and End Results database was queried for women between 70 and 79 years of age with invasive ductal carcinoma diagnosed between 1998 and 2007. This cohort was narrowed to women with T1mic-T1c, N0, estrogen receptor-positive, invasive ductal carcinoma treated with BCS with or without external beam radiation (EBRT). The primary endpoints were 5- and 10-year cause-specific survival (CSS). Univariate and multivariate analyses were performed. Propensity-score matching of T-stage, year of diagnosis, and age was utilized to reduce selection bias while comparing treatment arms within the grade 3 subgroup. RESULTS:A total of 12,036 women met inclusion criteria, and the median follow-up was 9.4 years. EBRT was omitted in 22% of patients, including 21% with grade 3 disease. Patients in the EBRT cohort were slightly younger (median, 74 vs. 75 years; P < .01) and had fewer T1a tumors (11% vs. 13%; P = .02). Histologic grades 1, 2, and 3 comprised 36%, 50%, and 14% of the cohort, respectively, and there were no differences in EBRT utilization by grade. Utilization of EBRT decreased following the publication of the CALGB trial in 2004 decreasing from 82% to 85% in 1998 to 2000 to 73% to 75% in 2005 to 2007 (P < .01). Unadjusted outcomes showed that in grade 1 disease, there were no differences in CSS with or without EBRT at 5 (99%) and 10 years (95%-96%). EBRT was associated with an improvement in CSS in grade 2 histology at 5 years (97% vs. 98%) and 10 years (92% vs. 95%) (P = .004). The benefit was more pronounced in grade 3 disease with CSS increasing from 93% to 96% at 5 years and from 87% to 92% at 10 years (P = .02) with EBRT. In the grade 3 subgroup, propensity-score matching confirmed EBRT was associated with superior CSS compared with surgery alone (hazard ratio, 0.58; 95% confidence interval, 0.34-0.98; P = .043). CONCLUSION:In this database analysis, omission of radiotherapy after BCS in elderly women with favorable-risk, early stage, grade 3 breast cancer was associated with inferior CSS. Further prospective data in this patient population are needed to confirm our findings and conclusions.
journal_name
Clin Breast Cancerjournal_title
Clinical breast cancerauthors
Escott CE,Zaenger D,Switchencko JM,Lin JY,Abugideiri M,Arciero CA,Pfister NT,Xu KM,Meisel JL,Subhedar P,Torres M,Curran WJ,Patel PRdoi
10.1016/j.clbc.2020.05.007subject
Has Abstractpub_date
2020-12-01 00:00:00pages
e701-e710issue
6eissn
1526-8209issn
1938-0666pii
S1526-8209(20)30109-9journal_volume
20pub_type
杂志文章abstract:BACKGROUND:Triple-negative breast cancer (TNBC) is an aggressive disease without established targeted treatment options for patients with metastatic disease. This study was undertaken to evaluate potentially actionable biomarkers in a large cohort of TNBC and compare them with non-TNBCs. MATERIALS AND METHODS:We evalu...
journal_title:Clinical breast cancer
pub_type: 杂志文章
doi:10.1016/j.clbc.2015.04.008
更新日期:2015-12-01 00:00:00
abstract::In addition to classical clinicopathologic factors, such as hormone receptor positivity, human epidermal growth factor receptor 2 (HER2) status, and tumor size, grade, and lymph node status, a number of commercially available genomic tests may be used to help inform treatment decisions for early breast cancer patients...
journal_title:Clinical breast cancer
pub_type: 杂志文章,评审
doi:10.1016/j.clbc.2020.01.001
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abstract::Involvement of axillary lymph nodes is an important prognostic factor in relationship to the management of breast cancer. However, the use of neoadjuvant systemic therapy is widespread in the treatment of positive axilla and such treatment leads to downstaging of axillary disease. Hence, the role of targeted axillary ...
journal_title:Clinical breast cancer
pub_type: 杂志文章
doi:10.1016/j.clbc.2018.06.001
更新日期:2018-10-01 00:00:00
abstract:BACKGROUND:Most investigations have compared triple-negative breast cancer (TNBC) to non-TNBC to elucidate clinical or epidemiologic differences between subtypes. We examined a contemporary cohort of patients with primary TNBC by detection and age at diagnosis within a population-based breast screening program to exami...
journal_title:Clinical breast cancer
pub_type: 杂志文章
doi:10.1016/j.clbc.2018.04.013
更新日期:2018-10-01 00:00:00
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journal_title:Clinical breast cancer
pub_type: 杂志文章
doi:10.1016/j.clbc.2018.11.001
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journal_title:Clinical breast cancer
pub_type: 杂志文章,评审
doi:10.3816/CBC.2005.n.033
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abstract::Breast cancer at age 21 is rare, even in individuals who have a genetic predisposition. These early diagnoses are usually the result of a hereditary cancer syndrome. Other contributing factors, such as chemotherapy and radiation for previous malignancies, can also increase the risk of secondary malignancies, including...
journal_title:Clinical breast cancer
pub_type: 杂志文章
doi:10.1016/j.clbc.2010.11.001
更新日期:2011-08-01 00:00:00
abstract::Breast cancer is one of the most frequently diagnosed malignancy among adolescent and young adult (AYA) women, accounting for approximately 14% of all AYA cancer diagnoses and 7% of all breast cancer. Breast cancer in AYA women is believed to represent a more biologically aggressive disease, but aside from commonly kn...
journal_title:Clinical breast cancer
pub_type: 杂志文章,评审
doi:10.1016/j.clbc.2014.06.002
更新日期:2014-12-01 00:00:00
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journal_title:Clinical breast cancer
pub_type: 临床试验,杂志文章
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更新日期:2018-02-01 00:00:00
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journal_title:Clinical breast cancer
pub_type: 杂志文章
doi:10.1016/j.clbc.2015.06.003
更新日期:2015-12-01 00:00:00
abstract:BACKGROUND:Spontaneous rib fractures (SRFs) are defined as fractures without apparent blunt force trauma. This study evaluated the incidence and risk factors of SRFs after treatment of patients with breast cancer based on bone scans. In addition, we analyzed radiation-associated SRFs and identified radiotherapy (RT) fa...
journal_title:Clinical breast cancer
pub_type: 杂志文章
doi:10.1016/j.clbc.2020.07.009
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journal_title:Clinical breast cancer
pub_type: 杂志文章
doi:10.1016/j.clbc.2016.07.007
更新日期:2016-12-01 00:00:00
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journal_title:Clinical breast cancer
pub_type: 杂志文章
doi:10.1016/j.clbc.2020.09.014
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abstract::Preliminary results of a phase II study of gemcitabine plus trastuzumab in previously treated (up to 3 previous regimens) metastatic breast cancer patients are presented. Patients had histologically confirmed metastatic breast cancer, with 2+ or 3+ tumor HER2 expression. Treatment consisted of gemcitabine 1200 mg/m2 o...
journal_title:Clinical breast cancer
pub_type: 临床试验,杂志文章
doi:10.3816/cbc.2002.s.004
更新日期:2002-05-01 00:00:00
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journal_title:Clinical breast cancer
pub_type: 杂志文章
doi:10.3816/CBC.2007.n.029
更新日期:2007-08-01 00:00:00
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journal_title:Clinical breast cancer
pub_type: 杂志文章,多中心研究
doi:10.3816/CBC.2010.n.029
更新日期:2010-06-01 00:00:00
abstract::In a review of current information on aromatase inhibitors (AIs) and their use in breast cancer treatment and prevention, published reports were obtained through a Medline search. Tamoxifen, a selective estrogen receptor modulator, is approved for use in metastatic breast cancer (MBC), the adjuvant treatment of breast...
journal_title:Clinical breast cancer
pub_type: 杂志文章,评审
doi:10.3816/CBC.2005.n.006
更新日期:2005-04-01 00:00:00
abstract:BACKGROUND:In first-line treatment of metastatic breast cancer, the best use of the available therapeutic agents is unclear. This study evaluated the efficacy and safety of combined therapy with bevacizumab and gemcitabine. PATIENTS:Women who were to undergo first-line treatment for locoregionally recurrent or metasta...
journal_title:Clinical breast cancer
pub_type: 杂志文章,多中心研究
doi:10.1016/j.clbc.2012.07.004
更新日期:2012-10-01 00:00:00
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journal_title:Clinical breast cancer
pub_type: 杂志文章,多中心研究,随机对照试验
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journal_title:Clinical breast cancer
pub_type: 杂志文章,评审
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journal_title:Clinical breast cancer
pub_type: 杂志文章
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journal_title:Clinical breast cancer
pub_type: 杂志文章
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journal_title:Clinical breast cancer
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.clbc.2017.06.007
更新日期:2018-02-01 00:00:00
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journal_title:Clinical breast cancer
pub_type: 杂志文章
doi:10.1016/j.clbc.2019.02.006
更新日期:2019-06-01 00:00:00
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journal_title:Clinical breast cancer
pub_type: 杂志文章
doi:10.1016/j.clbc.2014.11.002
更新日期:2015-04-01 00:00:00
abstract::A pilot chemoprevention study from the Royal Marsden Hospital in the United Kingdom demonstrated that tamoxifen could be administered safely to healthy women. This led to the establishment of multicenter trials, including the National Surgical Adjuvant Breast and Bowel Project (NSABP) P-1 and Italian National Cancer I...
journal_title:Clinical breast cancer
pub_type: 杂志文章,评审
doi:10.3816/CBC.2001.n.008
更新日期:2001-04-01 00:00:00
abstract:BACKGROUND:We studied the extent of BRCA1/2 genetic testing to help select the surgical approach for patients with breast cancer in Japan remains unclear. PATIENTS AND METHODS:The study subjects were female patients with primary unilateral invasive breast cancer considered as candidates for breast-conserving surgery w...
journal_title:Clinical breast cancer
pub_type: 杂志文章
doi:10.1016/j.clbc.2020.08.004
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journal_title:Clinical breast cancer
pub_type: 杂志文章
doi:10.3816/CBC.2009.n.018
更新日期:2009-05-01 00:00:00
abstract::Breast-conserving therapy (BCT) consists of segmental mastectomy followed by postoperative radiation therapy (RT) to the whole breast. At least 6 prospective randomized trials have proven the equivalence of BCT to mastectomy. However, BCT remains underused and, most importantly, a sizable proportion of patients with i...
journal_title:Clinical breast cancer
pub_type: 杂志文章,评审
doi:10.3816/cbc.2003.n.030
更新日期:2003-10-01 00:00:00
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journal_title:Clinical breast cancer
pub_type: 杂志文章
doi:10.1016/j.clbc.2016.06.018
更新日期:2017-02-01 00:00:00