title: Adjuvant radiation use in older women with early-stage breast cancer at Johns Hopkins.
abstract: In 2004, The National Comprehensive Cancer Network (NCCN) Guidelines incorporated omission of radiation therapy after breast-conservation surgery in women ≥70 years old with stage I, estrogen receptor-positive breast cancer who plan to receive endocrine therapy. One study demonstrated wide variation in implementing this change across 13 NCCN institutions. We evaluated the practice pattern at our institution.
  
  
  
  We identified women ≥70 years old treated at our institution from 2009 to 2014. We calculated radiation therapy omission rate in those meeting the guidelines. We explored associations between radiation therapy omission, year of diagnosis, and patient characteristics with Wilcoxon rank sum tests and Fisher's exact tests.
  
  
  
  A total of 667 women met the inclusion criteria, and 117 (18 %) were candidates for radiation therapy omission. Mean age among the 117 was 76.3 years (Range: 70-95). Overall radiation therapy omission rate was 36.8 %, but varied greatly by year of diagnosis (Range: 7.7-54.5 %). This variation persisted after excluding women who did not receive endocrine therapy (Mean: 39.0 %, Range: 0.0-75.0 %). Factors associated with higher radiation therapy omission rates included older age and not having pathological nodal evaluation. The radiation therapy omission rate did not vary by race, tumor type, grade, or size.
  
  
  
  The implementation of the NCCN guideline has not been consistent at our institution. Our data suggest that other tools should be considered to apply the guidelines more consistently. We have implemented a quality improvement protocol that incorporates life expectancy estimate and geriatric assessment in women meeting the NCCN guideline at our institution.
authors.affiliation: Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.
authors.forename: YaoYao G
authors.initials: YG
authors.lastname: Pollock
authors.affiliation: The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Blackford
authors.affiliation: The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Stacie C
authors.initials: SC
authors.lastname: Jeter
authors.affiliation: The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Jean
authors.initials: J
authors.lastname: Wright
authors.affiliation: The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Ashley
authors.initials: A
authors.lastname: Cimino-Mathews
authors.affiliation: The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Camp
authors.affiliation: The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Harvey
authors.affiliation: The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Fariba
authors.initials: F
authors.lastname: Asrari
authors.affiliation: Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Schoenborn
authors.affiliation: The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA. vstearn1@jhmi.edu.|Breast Cancer Research Chair in Oncology, Johns Hopkins University School of Medicine, 1650 Orleans Street, Room 144, Baltimore, MD, 21287, USA. vstearn1@jhmi.edu.
authors.forename: Vered
authors.identifier: 0000-0003-4018-4708
authors.initials: V
authors.lastname: Stearns
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology* / Q000532:radiotherapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D016896:Treatment Outcome
keywords: Early-stage breast cancer; Geriatric assessment; Geriatric oncology; Older adults; Radiation oncology