Breast Cancer

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TU_4_3359 - The optimal adjuvant treatment in older patients with hormone receptor positive early stage breast cancer (BC) is breast radiation (RT) not endocrine therapy (ET)

Tuesday, October 23
2:45 PM - 4:15 PM
Location: Innovation Hub, Exhibit Hall 3

The optimal adjuvant treatment in older patients with hormone receptor positive early stage breast cancer (BC) is breast radiation (RT) not endocrine therapy (ET)
M. Chadha1, T. Shao2, P. Klein2, S. Malamud2, S. Cate2, C. White2, and S. K. Boolbol3; 1Icahn School of Medicine at Mount Sinai, New York, NY, 2Mount Sinai Downtown, New York, NY, 3Mount Sinai Beth Israel Medical Center, New York, NY

Purpose/Objective(s): Randomized trials in older postmenopausal patients have studied the role of adjuvant endocrine therapy (ET) alone vs. ET + breast radiation (RT) following breast conserving surgery (BCS). These studies conclude that adjuvant ET alone constitutes optimal treatment. However, none of the randomized data provide an opportunity to evaluate the baseline risk for distant relapse and the incremental benefit of ET on breast cancer- specific outcomes in older postmenopausal patients. Furthermore, a high percentage of patients are non-compliant to the 5-year schedule of ET, and the side effects of ET are often cited to negatively impact patients’ quality of life. The objective of our study is to evaluate clinical outcomes, including overall survival, local and distant disease-free survival in a cohort of older patients diagnosed with hormone receptor positive breast cancer (BC) and who underwent surgery (S) ± RT but received no adjuvant ET.

Materials/Methods: From our institution breast cancer database, we identified 1,172 patients who are ≥ 65 years of age and had node negative, hormone receptor positive BC. Post-operatively, 149 patients received chemotherapy + RT, and 905 patients were prescribed ET ± RT. The remaining 118 patients received no adjuvant ET ± RT, and are the subject of this study. Various clinical and treatment factors were collected, and outcomes including overall survival, local and distant disease-free survival was estimated using the KM method.

Results: The median age is 75 years (65 to 93 years). Among the 118 patients, mastectomy was performed in 26 (22%) patients and 92 patients (78%) underwent BCS and sentinel lymphadenectomy or level I/II axillary sampling. Following BCS, 40% (37/92) of patients received RT. Majority (95%) patients had stage I disease, and the median T-size was 7mm. The median follow up is 62.5 months. The 5-year overall survival and disease-free survival is 52.5% and 74.2%, respectively. For patients treated with BCS (n=92), the 5-year disease-free survival with S alone and S + RT is 65.8% and 96.7%, respectively (p=0.008). The local disease-free survival for S alone and S + RT is 85.5% and 97.3%, respectively (p=0.02). The distant disease-free survival for S alone and S + RT was 98.2% and 100%, respectively.

Conclusion: Our study suggests that in the older postmenopausal patients the most common event is local relapse, and the risk of distant relapse is very low. When balancing disease outcomes and quality of life in context with the observed pattern of relapse, one might conclude that breast RT not ET is the optimal adjuvant treatment in older patients with hormone receptor positive early stage BC. The currently accepted practice of S + adjuvant ET alone needs to be re-evaluated. More importantly, further study is warranted to establish the risk for distant relapse in the older postmenopausal patients and the therapeutic benefit from ET.

Author Disclosure: M. Chadha: None. T. Shao: None. P. Klein: None. S. Malamud: None. S.K. Boolbol: None.

Manjeet Chadha, MD, FASTRO

Mount Sinai Beth Israel Medical Center

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