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Breast Cancer in the Older Woman - Is Radiation Necessary?

Breast Cancer in the Older Woman - Is Radiation Necessary?. Kevin S.Hughes, MD, FACS Co-Director, Avon Comprehensive Breast Evaluation Center Massachusetts General Hospital Harvard Medical School. American Society of Breast Surgeons Phoenix, Arizona 2012. Date 06/01/2007.

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Breast Cancer in the Older Woman - Is Radiation Necessary?

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  1. Breast Cancer in the Older Woman - Is Radiation Necessary? Kevin S.Hughes, MD, FACS Co-Director, Avon Comprehensive Breast Evaluation Center Massachusetts General Hospital Harvard Medical School American Society of Breast Surgeons Phoenix, Arizona 2012 Date 06/01/2007

  2. 1.9 cm, ER+, clinical N0 Cancer Lumpectomy Plus Radiation/Boost Tamoxifen Sentinel Node Chemotherapy BRCA testing

  3. 1.9 cm, ER+, clinical N0 Cancer Lumpectomy Plus Radiation/Boost Tamoxifen Sentinel Node Chemotherapy BRCA testing Lumpectomy Plus Radiation/Boost Tamoxifen/AI Sentinel Node Chemotherapy BRCA testing

  4. Can we Vs should we?

  5. CALGB 9343Comparison of Lumpectomy Plus Tamoxifen With and Without Irradiation in Women 70 or Older with Clinical Stage I, ER+ Breast Carcinoma Kevin S. Hughes, Lauren A. Schnaper, Constance Cirrincione, Donald Berry, Barbara L. Smith, Beryl McCormick, Hyman B. Muss, Clifford Hudis, Eric Winer Cancer and Leukemia Group B Radiation Therapy Oncology Group Eastern Cooperative Oncology Group

  6. Concerns regarding this study • Patients randomized to no radiation would be inappropriately under-treated

  7. Concerns regarding this study • Patients randomized to receive no radiation would be inappropriately under-treated • Patients randomized to radiation therapy would be inappropriately over-treated

  8. RANDOMIZE CALGB 9343 ELIGIBILITYAge ³ 70 Clinically Node Negative Lumpectomy, Negative Margin Tumor size£ 2 cm ER Positive or Indeterminate STRATIFICATIONAge < 75³ 75Axillary DissectionYesNo Radiation Tamoxifen Tamoxifen

  9. CALGB 9343 • Opened July 15, 1994 • Closed February 26, 1999 647 patients • Eligible 631 • Ineligible 5 • Canceled/Never treated 11 Median follow-up 12 years

  10. Patient characteristics RT+Tam Tam Total treated 317 319 Age >75 176 (56%) 172 (54%) ER Positive 308 (97%) 310 (97%) Size < 2cm 295 (93%) 296 (93%) No Ax dissection 200 (63%) 203 (64%)

  11. IBTR (Ipsilateral Breast Tumor Recurrence) 98% 91%

  12. Ipsilateral cancer risk

  13. Radiation decreases local recurrence by ~7% Does it do anything else?

  14. No RT • IBTR 6 • 4 • RT • Mastectomy • 10 • IBTR • 27 • 18 • Lumpectomy

  15. D. Berry 8/28/11 Actuarial survival for given ages at entry

  16. Ultimate Outcome

  17. CONCLUSION: In older women, the benefits of radiation after lumpectomy are small 22 women With modern margins and AI’s, RT will likely have even less benefit

  18. AS OF 2007, LITTLE CHANGE IN PRACTICE

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