Adjuvant chemotherapy and differential invasive breast cancer specific survival in elderly women

612 Background: A recent Cochrane review of seven randomised trials involving 1,446 elderly women (unselected for oestrogen receptor (ER) status) has shown no significant difference in overall survival between surgery (with or without adjuvant tamoxifen) and primary endocrine therapy using tamoxifen. We now report results of a large series from a single centre with a dedicated elderly breast cancer service, with long term follow-up. Methods: During a period of > 20 years, 1,031 elderly (> 70 years) women with ER positive (H-score >50) early operable primary breast cancer received either surgery (with or without adjuvant endocrine therapy) (N = 436) or primary endocrine therapy (N = 595) (>80% using tamoxifen) as initial treatment, with complete follow-up information till deaths. The initial treatment was decided based on fitness for surgery and patient choice. Analysis was carried out on breast cancer specific survival and degree of ER positivity. Results: After a median follow up of 49 months (range 0 - 261 months), patients between 70 - 80 years, treated by surgery, had better 5-year breast cancer specific survival compared to their counterparts treated by primary endocrine therapy (95% versus 85%; p < 0.001). For patients > 80 years, there was however no statistical difference between the two groups (90% versus 90%; p = 0.813). The median survival has not reached yet in all groups. Patients in the latter group (> 80 years) were found to have a higher chance of having strongly ER positive tumours (57% versus 50% in patients between 70 - 80 years with H-score >200; p- < 0.02). Conclusions: In a selected group of elderly women (> 80 years) who tend to have strongly ER positive tumours, surgery and primary endocrine therapy did not appear to produce any difference in breast cancer specific survival. This subject is currently being investigated in a national randomised trial in the UK. No significant financial relationships to disclose.

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Abstract P5-15-01: Breast cancer specific survival in 38,568 patients with node negative hormone receptor positive invasive breast cancer and oncotype DX recurrence score results in the SEER database

10.1158/1538-7445.sabcs15-p5-15-01 ◽

2016 ◽

Cited By ~ 12

Author(s):

S Shak ◽

VI Petkov ◽

DP Miller ◽

N Howlader ◽

N Gliner ◽

...

Keyword(s):

Breast Cancer ◽

Invasive Breast Cancer ◽

Hormone Receptor ◽

Recurrence Score ◽

Breast Cancer Specific Survival ◽

Seer Database ◽

Cancer Specific Survival ◽

Node Negative ◽

Hormone Receptor Positive ◽

Oncotype Dx Recurrence Score

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1–52 Radiotherapy omission after breast-conserving surgery is associated with reduced breast cancer–specific survival in elderly women with breast cancer

Breast Diseases A Year Book Quarterly ◽

10.1016/s1043-321x(07)80075-0 ◽

2007 ◽

Vol 18 (1) ◽

pp. 87-88

Author(s):

B.D. Smith

Keyword(s):

Breast Cancer ◽

Elderly Women ◽

Breast Conserving Surgery ◽

Breast Cancer Specific Survival ◽

Cancer Specific Survival

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Audit of local recurrence following breast conservation surgery with 5-mm target margin and hypofractionated 40-Gray breast radiotherapy for invasive breast cancer

Annals of The Royal College of Surgeons of England ◽

10.1308/003588410x12699663903476 ◽

2010 ◽

Vol 92 (7) ◽

pp. 562-568 ◽

Cited By ~ 8

Author(s):

Siong-Seng Liau ◽

Massimiliano Cariati ◽

David Noble ◽

Charles Wilson ◽

Gordon C Wishart

Keyword(s):

Breast Cancer ◽

Invasive Breast Cancer ◽

Breast Conservation ◽

Breast Conserving Surgery ◽

Breast Conservation Surgery ◽

Breast Cancer Specific Survival ◽

Breast Radiotherapy ◽

Cancer Specific Survival ◽

Conservation Surgery

INTRODUCTION The risk of ipsilateral breast tumour recurrence (IBTR) following breast conservation surgery (BCS) for invasive breast cancer (IBC) and radiotherapy is dependent on patient-, tumour- and treatment-related variables. In the Cambridge Breast Unit, breast conserving surgery has been performed with a target radial margin of 5 mm for IBC, in combination with 40-Gy hypofractionated (15 fractions) breast radiotherapy, since 1999. PATIENTS AND METHODS An audit was performed of cases treated between 1999 and 2004. A total of 563 patients underwent BCS for invasive breast cancer with 90.4% receiving radiotherapy (RT) and 60.4% of patients receiving boost RT (3 fractions of 3-Gy). RESULTS After a median follow-up of 58 months, five of the 563 (0.9%) patients developed IBTR. The 5-year actuarial IBTR rate was 1.1%. In terms of distant disease recurrence (DDR), 29 of the 563 (5.2%) had DDR during follow-up, giving a 5-year actuarial DDR rate of 5.4%. The 5-year breast cancer specific survival was 95%, with the poorer NPI groups having worse breast cancer specific survival (Log-rank, P < 0.0001). More importantly, patients with IBTR had a shorter breast cancer-specific survival than those who were IBTR-free (Log-rank, P < 0.0001). CONCLUSIONS Our treatment regimen, combining BCS with a 5-mm target margin and hypofractionated 40-Gy RT, results in an extremely low rate of IBTR, and compares favourably with the target IBTR rate of < 5% defined by the Association of Breast Surgeons (ABS) at BASO guidelines.

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