Adjuvant Radiotherapy May Benefit Elderly ER- Breast Cancer Patients Interview with:
Emily C. Daugherty, MD
Upstate Medical University
Radiation Oncology Resident, PGY-4 What is the background for this study?

Response: Adjuvant radiation following breast conserving surgery has been well
established in the management of early-stage breast cancer as it has
been shown to decrease the incidence of ipsilateral breast tumor
recurrences and also reduce breast cancer mortality. Large prospective
trials have shown for elderly patients with favorable, ER positive
pathology, omission of radiation after lumpectomy can be considered.

However, women with ER negative disease were typically not included in
these trials and given their higher risk for relapse as well as lack of
effective endocrine therapy, we hypothesized that adjuvant radiation
would benefit women over 70 years with early-stage, ER negative tumors. What are the main findings?

Response: Our analysis of the SEER database, which included over 5,000 patients,
demonstrated a significant 5-year overall- and cancer-specific survival
benefit. This is contrary to known prospective data in similar
populations with ER positive disease. This is important especially given
the potential impact of medical comorbidities on overall survival for
women over 70 years of age. The finding that a local therapy
significantly improves cancer-specific survival emphasizes the
importance of at least considering radiotherapy in this population. What should readers take away from your report?

Response: Adjuvant radiotherapy should be discussed in elderly, ER negative
patients as we found a significant overall and importantly, breast
cancer-specific survival benefit to the addition of radiation following
breast-conservation surgery. Oncologic decision making will continue to
be complicated by a growing and heterogeneous elderly population in the
United States.

Given that most ER negative breast cancer recurrences
occur within 5 years of diagnosis, even patients predicted to otherwise
have limited life spans may benefit from adjuvant radiotherapy. What recommendations do you have for future research as a result of this study?

Response: Prospective, randomized studies further evaluating the benefits of
adjuvant radiotherapy in women over 70 with ER negative breast cancer
should be pursued. Is there anything else you would like to add?

Response: A thorough discussion of the risk-to-benefit ratio in applicable,
elderly oncology patients should occur with attention to both
individualized goals of treatment and results of our analysis. Thank you for your contribution to the community.


Daugherty E, Daugherty M, Bogart J, Shapiro A. Adjuvant radiation
improves survival in older women following breast-conserving surgery for
estrogen receptor-negative breast cancer. Clinical breast cancer.

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on November 23, 2016 by Marie Benz MD FAAD