title: Adjuvant Radiation Improves Survival in Older Women Following Breast-Conserving Surgery for Estrogen Receptor-Negative Breast Cancer.
abstract: Published prospective trials have questioned the role of post-lumpectomy radiotherapy in older women with early-stage, estrogen receptor-positive (ER+) breast cancer. As the population with ER-tumors may be at greater risk for relapse, particularly given that endocrine therapy is not effective, we hypothesize the addition of radiation would be of benefit in patients age ≥ 70.
  
  
  
  The Surveillance, Epidemiology, and End Results database was queried from 1998 to 2011 for patients age ≥ 70 years receiving breast-conserving surgery for T1, ER-invasive ductal carcinoma. Patients were separated into 2 cohorts: those treated with and without adjuvant radiotherapy. Chi-square analysis, unpaired t test and Kaplan-Meier log-rank were used to compare patient and tumor characteristics as well as overall and cancer-specific survival between the cohorts.
  
  
  
  Overall, 3685 patients received radiation and 1493 patients received lumpectomy alone. Patients treated with adjuvant radiation were younger (median age 76 vs. 78 years, P < .0001). Patients who received radiation had improved overall survival, with 5-year survival rates of 81.0% versus 61.7% without radiation (P < .0001). Cancer-specific survival was also improved with radiotherapy, with 5-year cancer-specific survival rates of 93.1% versus 85.0% (P < .0001).
  
  
  
  This analysis of the SEER database demonstrates that women ages 70 and older treated with lumpectomy and radiotherapy for ER-, early-stage breast cancer have improved overall survival and breast cancer-specific survival compared with patients treated with lumpectomy alone. This information may help in the decision-making process for this patient population.
authors.affiliation: Department of Radiation Oncology, Upstate Cancer Center, SUNY Upstate Medical University, Syracuse, NY. Electronic address: daughere@upstate.edu.
authors.forename: Emily C
authors.initials: EC
authors.lastname: Daugherty
authors.affiliation: Department of Urology, SUNY Upstate Medical University, Syracuse, NY.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Daugherty
authors.affiliation: Department of Radiation Oncology, Upstate Cancer Center, SUNY Upstate Medical University, Syracuse, NY.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Bogart
authors.affiliation: Department of Radiation Oncology, Upstate Cancer Center, SUNY Upstate Medical University, Syracuse, NY.
authors.forename: Anna
authors.initials: A
authors.lastname: Shapiro
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D015412:Mastectomy, Segmental; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D011960:Receptors, Estrogen / Q000378:metabolism; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D011960:Receptors, Estrogen
keywords: Breast conservation; ER-negative; Elderly; Radiotherapy; SEER