In a recent publication from the British Columbia Cancer Agency focusing on the role of adjuvant breast radiotherapy in elderly patients, our team examined survival outcomes in a cohort of 4836 women aged 50-89 with T1-2, N0-1, M0 breast cancer treated with and without radiotherapy after breast conserving surgery. 

The analysis revealed that the use of adjuvant RT significant decreased with advancing age.  RT was omitted in 9% of patients aged 65-74 and 26% of patients aged 75+ years.  The omission of RT was significantly associated with lower local control, breast cancer-specific survival, and overall survival. Focusing on the subset of elderly patients aged 75+ years, the investigators also found that despite having similar tumor characteristics and higher rates of systemic therapy use, women who did not receive RT had poorer breast cancer specific survival compared to women who received RT.  These findings support the hypothesis that inadequate local therapy can adversely impact survival in elderly women treated with breast conserving therapy. 

Adjuvant therapy decisions require balancing of benefits and adverse effects and careful consideration of the individual patient's age, comorbid conditions, and priorities.  Innovative strategies such as accelerated partial breast RT delivering adjuvant RT over shorter treatment durations are being prospectively evaluated and may offer elderly patients improved convenience and access.  These trials should include adequate samples of older subjects to ensure that the results are relevant to our aging population.

 

Bibliographical reference:

Truong PT et al.: "Radiotherapy omission after breast-conserving surgery is associated with reduced breast cancer-specific survival in elderly women with breast cancer", Am J Surg. 2006 Jun;191(6):749-755

 

Pauline Truong

Columbia Cancer Agency, Vancouver Island Centre, British Columbia Cancer Agency, Victoria, BC, Canada