De-escalation of surgical and radiation treatment in elderly luminal breast cancer patients, single institution report and review of the evidence
Abstract Background De-intensification of anti-cancer therapy without significantly affecting outcomes is an important goal. Omission of axillary surgery or breast radiation is considered a reasonable option in elderly patients with early-stage breast cancer and good prognostic factors. Data on avoi...
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| Format: | Article |
| Language: | English |
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BMC
2025-01-01
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| Series: | World Journal of Surgical Oncology |
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| Online Access: | https://doi.org/10.1186/s12957-024-03635-8 |
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| author | Yasmin Korzets Marian Khatib Hadar Goldvaser Yehiel Hibshoosh Alla Nikolaevski-Berlin Ido Wolf Viacheslav Soyfer |
| author_facet | Yasmin Korzets Marian Khatib Hadar Goldvaser Yehiel Hibshoosh Alla Nikolaevski-Berlin Ido Wolf Viacheslav Soyfer |
| author_sort | Yasmin Korzets |
| collection | DOAJ |
| description | Abstract Background De-intensification of anti-cancer therapy without significantly affecting outcomes is an important goal. Omission of axillary surgery or breast radiation is considered a reasonable option in elderly patients with early-stage breast cancer and good prognostic factors. Data on avoidance of both axillary surgery and radiation therapy (RT) is scarce and inconclusive. Methods A retrospective cohort study comprising all women aged 70 years and older diagnosed with early, hormone receptor (HR) positive, HER2-negative breast cancer treated with breast-conserving surgery (BCS) without sentinel lymph node biopsy (SLNB) and RT in a large tertiary center (between 2016 and 2021). Data on patient and tumor characteristics as well as outcomes including local recurrence, loco-regional recurrence, distant metastases, and death were extracted. Disease free survival (DFS) was assessed by Kaplan-Meier analysis. The Cox proportional hazard regression model was performed to identify factors (demographic and clinical characteristics of the patients) that predict the disease recurrence or death. Results A total of 100 women were included, median age of patients was 81. All patients had clinically node-negative disease with a median tumor size was 13 mm. Five (5%) women had lymphovascular invasion. At a median follow-up of 3.9 years, there were 7 (7%) recurrences, 4 local, 2 local-regional, and one distant. The median DFS for the entire group was 42 months (11–128). Eight patients (8%) died, 5 of them for reasons unrelated to breast cancer (3 of unknown reason). Tumor size larger than 13 mm was associated with significantly worse DFS (HR = 4.02, 95% CI 1.08–14.99, p = 0.04). Conclusion Omission of both SLNB and adjuvant RT is feasible in elderly, early breast cancer patients with small luminal tumors. |
| format | Article |
| id | doaj-art-77069eaca1e646b8958f936dc49a4af5 |
| institution | Kabale University |
| issn | 1477-7819 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | World Journal of Surgical Oncology |
| spelling | doaj-art-77069eaca1e646b8958f936dc49a4af52025-01-05T12:32:16ZengBMCWorld Journal of Surgical Oncology1477-78192025-01-012311810.1186/s12957-024-03635-8De-escalation of surgical and radiation treatment in elderly luminal breast cancer patients, single institution report and review of the evidenceYasmin Korzets0Marian Khatib1Hadar Goldvaser2Yehiel Hibshoosh3Alla Nikolaevski-Berlin4Ido Wolf5Viacheslav Soyfer6Institute of Oncology,Tel Aviv Sourasky Medical CenterFaculty of Medicine, Tel Aviv UniversityInstitute of Oncology, Shaare Zedek Medical CenterUniversity of CaliforniaInstitute of Oncology,Tel Aviv Sourasky Medical CenterInstitute of Oncology,Tel Aviv Sourasky Medical CenterInstitute of Oncology,Tel Aviv Sourasky Medical CenterAbstract Background De-intensification of anti-cancer therapy without significantly affecting outcomes is an important goal. Omission of axillary surgery or breast radiation is considered a reasonable option in elderly patients with early-stage breast cancer and good prognostic factors. Data on avoidance of both axillary surgery and radiation therapy (RT) is scarce and inconclusive. Methods A retrospective cohort study comprising all women aged 70 years and older diagnosed with early, hormone receptor (HR) positive, HER2-negative breast cancer treated with breast-conserving surgery (BCS) without sentinel lymph node biopsy (SLNB) and RT in a large tertiary center (between 2016 and 2021). Data on patient and tumor characteristics as well as outcomes including local recurrence, loco-regional recurrence, distant metastases, and death were extracted. Disease free survival (DFS) was assessed by Kaplan-Meier analysis. The Cox proportional hazard regression model was performed to identify factors (demographic and clinical characteristics of the patients) that predict the disease recurrence or death. Results A total of 100 women were included, median age of patients was 81. All patients had clinically node-negative disease with a median tumor size was 13 mm. Five (5%) women had lymphovascular invasion. At a median follow-up of 3.9 years, there were 7 (7%) recurrences, 4 local, 2 local-regional, and one distant. The median DFS for the entire group was 42 months (11–128). Eight patients (8%) died, 5 of them for reasons unrelated to breast cancer (3 of unknown reason). Tumor size larger than 13 mm was associated with significantly worse DFS (HR = 4.02, 95% CI 1.08–14.99, p = 0.04). Conclusion Omission of both SLNB and adjuvant RT is feasible in elderly, early breast cancer patients with small luminal tumors.https://doi.org/10.1186/s12957-024-03635-8BreastRadiationOmissionSentinel lymph node biopsy |
| spellingShingle | Yasmin Korzets Marian Khatib Hadar Goldvaser Yehiel Hibshoosh Alla Nikolaevski-Berlin Ido Wolf Viacheslav Soyfer De-escalation of surgical and radiation treatment in elderly luminal breast cancer patients, single institution report and review of the evidence World Journal of Surgical Oncology Breast Radiation Omission Sentinel lymph node biopsy |
| title | De-escalation of surgical and radiation treatment in elderly luminal breast cancer patients, single institution report and review of the evidence |
| title_full | De-escalation of surgical and radiation treatment in elderly luminal breast cancer patients, single institution report and review of the evidence |
| title_fullStr | De-escalation of surgical and radiation treatment in elderly luminal breast cancer patients, single institution report and review of the evidence |
| title_full_unstemmed | De-escalation of surgical and radiation treatment in elderly luminal breast cancer patients, single institution report and review of the evidence |
| title_short | De-escalation of surgical and radiation treatment in elderly luminal breast cancer patients, single institution report and review of the evidence |
| title_sort | de escalation of surgical and radiation treatment in elderly luminal breast cancer patients single institution report and review of the evidence |
| topic | Breast Radiation Omission Sentinel lymph node biopsy |
| url | https://doi.org/10.1186/s12957-024-03635-8 |
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