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Background <p>De-intensification of anti-cancer therapy without significantly affecting outcomes is an important goal. Omission of axillary surgery or breast radiation is considered a reasonable option in elderly patients with early-stage breast cancer and good prognostic factors. Data on avoidance of both axillary surgery and radiation therapy (RT) is scarce and inconclusive.</p> Methods <p>A retrospective cohort study comprising all women aged 70 years and older diagnosed with early, hormone receptor (HR) positive, HER2-negative breast cancer treated with breast-conserving surgery (BCS) without sentinel lymph node biopsy (SLNB) and RT in a large tertiary center (between 2016 and 2021). Data on patient and tumor characteristics as well as outcomes including local recurrence, loco-regional recurrence, distant metastases, and death were extracted. Disease free survival (DFS) was assessed by Kaplan-Meier analysis. The Cox proportional hazard regression model was performed to identify factors (demographic and clinical characteristics of the patients) that predict the disease recurrence or death.</p> Results <p>A total of 100 women were included, median age of patients was 81. All patients had clinically node-negative disease with a median tumor size was 13&#xa0;mm. Five (5%) women had lymphovascular invasion. At a median follow-up of 3.9 years, there were 7 (7%) recurrences, 4 local, 2 local-regional, and one distant. The median DFS for the entire group was 42 months (11–128). Eight patients (8%) died, 5 of them for reasons unrelated to breast cancer (3 of unknown reason). Tumor size larger than 13&#xa0;mm was associated with significantly worse DFS (HR = 4.02, 95% CI 1.08–14.99, <i>p</i> = 0.04).</p> Conclusion <p>Omission of both SLNB and adjuvant RT is feasible in elderly, early breast cancer patients with small luminal tumors.</p>

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De-escalation of surgical and radiation treatment in elderly luminal breast cancer patients, single institution report and review of the evidence

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年1月3日

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  • Yasmin Korzets,
  • Marian Khatib,
  • Hadar Goldvaser,
  • Yehiel Hibshoosh,
  • Alla Nikolaevski-Berlin,
  • Ido Wolf,
  • Viacheslav Soyfer

摘要

Background

De-intensification of anti-cancer therapy without significantly affecting outcomes is an important goal. Omission of axillary surgery or breast radiation is considered a reasonable option in elderly patients with early-stage breast cancer and good prognostic factors. Data on avoidance of both axillary surgery and radiation therapy (RT) is scarce and inconclusive.

Methods

A retrospective cohort study comprising all women aged 70 years and older diagnosed with early, hormone receptor (HR) positive, HER2-negative breast cancer treated with breast-conserving surgery (BCS) without sentinel lymph node biopsy (SLNB) and RT in a large tertiary center (between 2016 and 2021). Data on patient and tumor characteristics as well as outcomes including local recurrence, loco-regional recurrence, distant metastases, and death were extracted. Disease free survival (DFS) was assessed by Kaplan-Meier analysis. The Cox proportional hazard regression model was performed to identify factors (demographic and clinical characteristics of the patients) that predict the disease recurrence or death.

Results

A total of 100 women were included, median age of patients was 81. All patients had clinically node-negative disease with a median tumor size was 13 mm. Five (5%) women had lymphovascular invasion. At a median follow-up of 3.9 years, there were 7 (7%) recurrences, 4 local, 2 local-regional, and one distant. The median DFS for the entire group was 42 months (11–128). Eight patients (8%) died, 5 of them for reasons unrelated to breast cancer (3 of unknown reason). Tumor size larger than 13 mm was associated with significantly worse DFS (HR = 4.02, 95% CI 1.08–14.99, p = 0.04).

Conclusion

Omission of both SLNB and adjuvant RT is feasible in elderly, early breast cancer patients with small luminal tumors.