Effectiveness of radiotherapy after breast-conserving surgery in older patients with T1-2N0 breast cancer

Anna Z. de Boer*, Esther Bastiaannet, Nienke A. de Glas, Perla J. Marang-van de Mheen, Olaf M. Dekkers, Sabine Siesling, Linda de Munck, Kelly M. de Ligt, Johanneke E.A. Portielje, Gerrit Jan Liefers

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

1 Citation (Scopus)
7 Downloads (Pure)

Abstract

Purpose: In the Netherlands, radiotherapy after breast-conserving surgery (BCS) is omitted in up to 30% of patients aged ≥ 75 years. Although omission of radiotherapy is considered an option for older women treated with endocrine treatment, the majority of these patients do not receive systemic treatment following Dutch treatment guidelines. Therefore, the aim of this study was to evaluate the effect of omission of radiotherapy on locoregional recurrence risk in this patient population. Methods: Patients aged ≥ 75 years undergone BCS for T1-2N0 breast cancer diagnosed between 2003 and 2009 were selected from the Netherlands Cancer Registry. To minimize confounding by indication, hospital variation was used to assess the impact of radiotherapy-use on locoregional recurrence risk using cox proportional hazards regression. Hazards ratios with 95% confidence interval (CI) were estimated. Results: Overall, 2390 patients were included. Of the patients with hormone receptor-positive breast cancer, 39.3% received endocrine treatment. Five-year incidences of locoregional recurrence were 1.9%, 2.8%, and 3.0% in patients treated at hospitals with higher (average radiotherapy-use 96.0%), moderate (88.0%), and lower radiotherapy-use (72.2%) respectively, and nine-year incidences were 2.2%, 3.1%, and 3.2% respectively. Adjusted hazard ratios were 1.46 (95% CI 0.77–2.78) and 1.50 (95% CI 0.79–2.85) for patients treated at hospitals with moderate and lower radiotherapy-use, compared to patient treated at hospitals with higher radiotherapy-use. Conclusions: Despite endocrine treatment in only 39.3%, locoregional recurrence risk was low, even in patients treated at hospitals with lower radiotherapy-use. This provides reasonable grounds to consider omission of radiotherapy in patients aged ≥ 75 years with T1-2N0 breast cancer.

Original languageEnglish
Pages (from-to)637-645
Number of pages9
JournalBreast cancer research and treatment
Volume178
Issue number3
Early online date26 Aug 2019
DOIs
Publication statusPublished - 1 Dec 2019

Fingerprint

Segmental Mastectomy
Radiotherapy
Breast Neoplasms
Recurrence
Confidence Intervals
Netherlands
Therapeutics
Incidence
Registries
Hormones
Guidelines

Keywords

  • UT-Hybrid-D
  • Breast-conserving treatment
  • Locoregional recurrence
  • Older patients
  • Breast cancer

Cite this

de Boer, A. Z., Bastiaannet, E., de Glas, N. A., Marang-van de Mheen, P. J., Dekkers, O. M., Siesling, S., ... Liefers, G. J. (2019). Effectiveness of radiotherapy after breast-conserving surgery in older patients with T1-2N0 breast cancer. Breast cancer research and treatment, 178(3), 637-645. https://doi.org/10.1007/s10549-019-05412-8
de Boer, Anna Z. ; Bastiaannet, Esther ; de Glas, Nienke A. ; Marang-van de Mheen, Perla J. ; Dekkers, Olaf M. ; Siesling, Sabine ; de Munck, Linda ; de Ligt, Kelly M. ; Portielje, Johanneke E.A. ; Liefers, Gerrit Jan. / Effectiveness of radiotherapy after breast-conserving surgery in older patients with T1-2N0 breast cancer. In: Breast cancer research and treatment. 2019 ; Vol. 178, No. 3. pp. 637-645.
@article{62458ce7691a45fa93bc57ac0cfecb66,
title = "Effectiveness of radiotherapy after breast-conserving surgery in older patients with T1-2N0 breast cancer",
abstract = "Purpose: In the Netherlands, radiotherapy after breast-conserving surgery (BCS) is omitted in up to 30{\%} of patients aged ≥ 75 years. Although omission of radiotherapy is considered an option for older women treated with endocrine treatment, the majority of these patients do not receive systemic treatment following Dutch treatment guidelines. Therefore, the aim of this study was to evaluate the effect of omission of radiotherapy on locoregional recurrence risk in this patient population. Methods: Patients aged ≥ 75 years undergone BCS for T1-2N0 breast cancer diagnosed between 2003 and 2009 were selected from the Netherlands Cancer Registry. To minimize confounding by indication, hospital variation was used to assess the impact of radiotherapy-use on locoregional recurrence risk using cox proportional hazards regression. Hazards ratios with 95{\%} confidence interval (CI) were estimated. Results: Overall, 2390 patients were included. Of the patients with hormone receptor-positive breast cancer, 39.3{\%} received endocrine treatment. Five-year incidences of locoregional recurrence were 1.9{\%}, 2.8{\%}, and 3.0{\%} in patients treated at hospitals with higher (average radiotherapy-use 96.0{\%}), moderate (88.0{\%}), and lower radiotherapy-use (72.2{\%}) respectively, and nine-year incidences were 2.2{\%}, 3.1{\%}, and 3.2{\%} respectively. Adjusted hazard ratios were 1.46 (95{\%} CI 0.77–2.78) and 1.50 (95{\%} CI 0.79–2.85) for patients treated at hospitals with moderate and lower radiotherapy-use, compared to patient treated at hospitals with higher radiotherapy-use. Conclusions: Despite endocrine treatment in only 39.3{\%}, locoregional recurrence risk was low, even in patients treated at hospitals with lower radiotherapy-use. This provides reasonable grounds to consider omission of radiotherapy in patients aged ≥ 75 years with T1-2N0 breast cancer.",
keywords = "UT-Hybrid-D, Breast-conserving treatment, Locoregional recurrence, Older patients, Breast cancer",
author = "{de Boer}, {Anna Z.} and Esther Bastiaannet and {de Glas}, {Nienke A.} and {Marang-van de Mheen}, {Perla J.} and Dekkers, {Olaf M.} and Sabine Siesling and {de Munck}, Linda and {de Ligt}, {Kelly M.} and Portielje, {Johanneke E.A.} and Liefers, {Gerrit Jan}",
note = "Springer deal",
year = "2019",
month = "12",
day = "1",
doi = "10.1007/s10549-019-05412-8",
language = "English",
volume = "178",
pages = "637--645",
journal = "Breast cancer research and treatment",
issn = "0167-6806",
publisher = "Springer",
number = "3",

}

de Boer, AZ, Bastiaannet, E, de Glas, NA, Marang-van de Mheen, PJ, Dekkers, OM, Siesling, S, de Munck, L, de Ligt, KM, Portielje, JEA & Liefers, GJ 2019, 'Effectiveness of radiotherapy after breast-conserving surgery in older patients with T1-2N0 breast cancer', Breast cancer research and treatment, vol. 178, no. 3, pp. 637-645. https://doi.org/10.1007/s10549-019-05412-8

Effectiveness of radiotherapy after breast-conserving surgery in older patients with T1-2N0 breast cancer. / de Boer, Anna Z.; Bastiaannet, Esther; de Glas, Nienke A.; Marang-van de Mheen, Perla J.; Dekkers, Olaf M.; Siesling, Sabine; de Munck, Linda; de Ligt, Kelly M.; Portielje, Johanneke E.A.; Liefers, Gerrit Jan.

In: Breast cancer research and treatment, Vol. 178, No. 3, 01.12.2019, p. 637-645.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Effectiveness of radiotherapy after breast-conserving surgery in older patients with T1-2N0 breast cancer

AU - de Boer, Anna Z.

AU - Bastiaannet, Esther

AU - de Glas, Nienke A.

AU - Marang-van de Mheen, Perla J.

AU - Dekkers, Olaf M.

AU - Siesling, Sabine

AU - de Munck, Linda

AU - de Ligt, Kelly M.

AU - Portielje, Johanneke E.A.

AU - Liefers, Gerrit Jan

N1 - Springer deal

PY - 2019/12/1

Y1 - 2019/12/1

N2 - Purpose: In the Netherlands, radiotherapy after breast-conserving surgery (BCS) is omitted in up to 30% of patients aged ≥ 75 years. Although omission of radiotherapy is considered an option for older women treated with endocrine treatment, the majority of these patients do not receive systemic treatment following Dutch treatment guidelines. Therefore, the aim of this study was to evaluate the effect of omission of radiotherapy on locoregional recurrence risk in this patient population. Methods: Patients aged ≥ 75 years undergone BCS for T1-2N0 breast cancer diagnosed between 2003 and 2009 were selected from the Netherlands Cancer Registry. To minimize confounding by indication, hospital variation was used to assess the impact of radiotherapy-use on locoregional recurrence risk using cox proportional hazards regression. Hazards ratios with 95% confidence interval (CI) were estimated. Results: Overall, 2390 patients were included. Of the patients with hormone receptor-positive breast cancer, 39.3% received endocrine treatment. Five-year incidences of locoregional recurrence were 1.9%, 2.8%, and 3.0% in patients treated at hospitals with higher (average radiotherapy-use 96.0%), moderate (88.0%), and lower radiotherapy-use (72.2%) respectively, and nine-year incidences were 2.2%, 3.1%, and 3.2% respectively. Adjusted hazard ratios were 1.46 (95% CI 0.77–2.78) and 1.50 (95% CI 0.79–2.85) for patients treated at hospitals with moderate and lower radiotherapy-use, compared to patient treated at hospitals with higher radiotherapy-use. Conclusions: Despite endocrine treatment in only 39.3%, locoregional recurrence risk was low, even in patients treated at hospitals with lower radiotherapy-use. This provides reasonable grounds to consider omission of radiotherapy in patients aged ≥ 75 years with T1-2N0 breast cancer.

AB - Purpose: In the Netherlands, radiotherapy after breast-conserving surgery (BCS) is omitted in up to 30% of patients aged ≥ 75 years. Although omission of radiotherapy is considered an option for older women treated with endocrine treatment, the majority of these patients do not receive systemic treatment following Dutch treatment guidelines. Therefore, the aim of this study was to evaluate the effect of omission of radiotherapy on locoregional recurrence risk in this patient population. Methods: Patients aged ≥ 75 years undergone BCS for T1-2N0 breast cancer diagnosed between 2003 and 2009 were selected from the Netherlands Cancer Registry. To minimize confounding by indication, hospital variation was used to assess the impact of radiotherapy-use on locoregional recurrence risk using cox proportional hazards regression. Hazards ratios with 95% confidence interval (CI) were estimated. Results: Overall, 2390 patients were included. Of the patients with hormone receptor-positive breast cancer, 39.3% received endocrine treatment. Five-year incidences of locoregional recurrence were 1.9%, 2.8%, and 3.0% in patients treated at hospitals with higher (average radiotherapy-use 96.0%), moderate (88.0%), and lower radiotherapy-use (72.2%) respectively, and nine-year incidences were 2.2%, 3.1%, and 3.2% respectively. Adjusted hazard ratios were 1.46 (95% CI 0.77–2.78) and 1.50 (95% CI 0.79–2.85) for patients treated at hospitals with moderate and lower radiotherapy-use, compared to patient treated at hospitals with higher radiotherapy-use. Conclusions: Despite endocrine treatment in only 39.3%, locoregional recurrence risk was low, even in patients treated at hospitals with lower radiotherapy-use. This provides reasonable grounds to consider omission of radiotherapy in patients aged ≥ 75 years with T1-2N0 breast cancer.

KW - UT-Hybrid-D

KW - Breast-conserving treatment

KW - Locoregional recurrence

KW - Older patients

KW - Breast cancer

UR - http://www.scopus.com/inward/record.url?scp=85071480852&partnerID=8YFLogxK

U2 - 10.1007/s10549-019-05412-8

DO - 10.1007/s10549-019-05412-8

M3 - Article

AN - SCOPUS:85071480852

VL - 178

SP - 637

EP - 645

JO - Breast cancer research and treatment

JF - Breast cancer research and treatment

SN - 0167-6806

IS - 3

ER -