Effects of Radiotherapy in Early-Stage, Low-Recurrence Risk, Hormone-Sensitive Breast Cancer
| Autor: | Timothy J. Whelan, Richard C. Zellars, Juhee Song, Joseph A. Sparano, Judith-Anne W. Chapman, Eric J. Feuer, Stewart J. Anderson, George Luta, Xuelin Huang, Anthony W Fyles, Jinani Jayasekera, Jeanne S. Mandelblatt, Thomas B. Julian, Donald A. Berry, Clyde B. Schechter, Willi Sauerbrei, Julia White, Yisheng Li, Reshma Jagsi |
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| Rok vydání: | 2018 |
| Předmět: |
0301 basic medicine
Oncology Cancer Research medicine.medical_specialty Antineoplastic Agents Hormonal medicine.medical_treatment Breast Neoplasms 03 medical and health sciences 0302 clinical medicine Breast cancer Internal medicine medicine Humans Stage (cooking) Aged Neoplasm Staging Proportional Hazards Models Aged 80 and over Clinical Trials as Topic Proportional hazards model business.industry Hazard ratio Lumpectomy Editorials Middle Aged medicine.disease Combined Modality Therapy Confidence interval Radiation therapy 030104 developmental biology 030220 oncology & carcinogenesis Hormonal therapy Female Radiotherapy Adjuvant Neoplasm Grading Neoplasm Recurrence Local business |
| Zdroj: | Journal of the National Cancer Institute. 110(12) |
| ISSN: | 1460-2105 |
| Popis: | Background Radiotherapy after breast conservation has become the standard of care. Prior meta-analyses on effects of radiotherapy predated availability of gene expression profiling (GEP) to assess recurrence risk and/or did not include all relevant outcomes. This analysis used GEP information with pooled individual-level data to evaluate the impact of omitting radiotherapy on recurrence and mortality. Methods We considered trials that evaluated or administered radiotherapy after lumpectomy in women with low-risk breast cancer. Women included had undergone lumpectomy and were treated with hormonal therapy for stage I, ER+ and/or PR+, HER2- breast cancer with Oncotype scores no greater than 18. Recurrence-free interval (RFI), type of RFI (locoregional or distant), and breast cancer-specific and overall survival were compared between no radiotherapy and radiotherapy using adjusted Cox models. All statistical tests were two-sided. Results The final sample included 1778 women from seven trials. Omission of radiotherapy was associated with an overall adjusted hazard ratio of 2.59 (95% confidence interval [CI] = 1.38 to 4.89, P = .003) for RFI. There was a statistically significant increase in any first locoregional recurrence (P = .001), but not distant recurrence events (P = .90), or breast cancer-specific (P = .85) or overall survival (P = .61). Five-year RFI rate was high (93.5% for no radiotherapy vs 97.9% for radiotherapy; absolute reduction = 4.4%, 95% CI = 0.7% to 8.1%, P = .03). The effects of radiotherapy varied across subgroups, with lower RFI rates for those with Oncotype scores of less than 11 (vs 11-18), older (vs younger), and ER+/PR+ status (vs other). Conclusions Omission of radiotherapy in hormone-sensitive patients with low recurrence risk may lead to a modest increase in locoregional recurrence event rates, but does not appear to increase the rate of distant recurrence or death. |
| Databáze: | OpenAIRE |
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