title: Impact of Her-2 Neu overexpression on outcome of elderly women treated with wide local excision and breast irradiation for early stage breast cancer: an exploratory analysis.
abstract: OBJECTIVE
  The purpose of this study was to investigate the prognostic significance of Her-2 neu status in elderly patients managed with breast conservation strategy for stage I-II breast cancer.
  
  
  METHODS
  We conducted an IRB approved retrospective review of 153 women age 70 and older with stage I-II breast cancer, managed with wide local excision and breast radiation between January 1997 and December 2002. The subset of 106 patients had a known Her-2 neu status and was analyzed for primary patient and tumor characteristics. These characteristics were correlated with cause specific survival (CSS), overall survival (OS), and combined nodal and distant failure (NDF). Her-2 neu positivity was confirmed with FISH HercepTestTM. Statistical tests included Cox regression, contingency table and Kaplan-Meier analysis.
  
  
  RESULTS
  Median follow-up was 55 months and patient's median age was 76. Twenty two percent of patients were Her-2 neu positive and 78% were Her-2 neu negative. Her-2 neu positivity was significantly associated with high histologic grade (P = 0.008), T2 stage (P = 0.001) and positive axillary lymph nodes (P = 0.02) among 73 patients who had surgical assessment of axilla. Overall, only 15 patients (14%) received chemotherapy. There were no recurrences in the breast. Her-2 neu positivity predicted for NDF and CSS on multivariate analysis. Projected 5-year freedom from NDF was 70% for Her-2 neu positive and 97% for Her-2 neu negative patients (P < 0.01, log-rank). CSS was 86% for Her-2 neu positive and 98% for Her-2 neu negative patients (P < 0.01, log-rank). OS was no different between Her-2 neu positive and Her-2 neu negative patients (80% versus 85%, P = 0.25).
  
  
  CONCLUSIONS
  Her-2 neu amplification predicts development of NDF and negatively influences CSS, but not local control or OS in elderly patients treated with breast conservation. Similar to the trend in younger patients, Her-2 neu positivity may be used in the future to consider more aggressive treatment strategies in elderly patients.
authors.affiliation: Department of Radiation Oncology, Kimmel Cancer Center of Jefferson Medical College, Thomas Jefferson University Hospital, Philadelphia, PA 19103, USA. igor.poltinnikov@mail.tju.edu
authors.forename: Igor M
authors.initials: IM
authors.lastname: Poltinnikov
authors.forename: Shari B
authors.initials: SB
authors.lastname: Rudoler
authors.forename: Yevgen
authors.initials: Y
authors.lastname: Tymofyeyev
authors.forename: Julia
authors.initials: J
authors.lastname: Kennedy
authors.forename: Pramila R
authors.initials: PR
authors.lastname: Anne
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Curran
mesh_terms: D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000235:genetics* / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D005784:Gene Amplification; D020869:Gene Expression Profiling; D006801:Humans; D015412:Mastectomy, Segmental; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000096:biosynthesis*; D012189:Retrospective Studies
chemical_list: D018719:Erb-b2 Receptor Tyrosine Kinases