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Background <p>We examined whether adjuvant radiation therapy (RT) monotherapy offers comparable overall survival (OS) to adjuvant endocrine therapy (ET) monotherapy following lumpectomy in women aged ≥ 65 years with favorable early stage breast cancer.</p> Patients and Methods <p>Patients aged ≥ 65 years, diagnosed with ER+/HER2−, cT1–2, N0 breast cancer, who underwent lumpectomy, were selected from the National Cancer Database (2004–2020). Kaplan–Meier estimates and Cox Proportional Hazards models evaluated OS differences across RT-only and ET-only groups.</p> Results <p>The final cohort included 91,505 patients, with 11.8% receiving RT alone and 29.5% receiving ET only. Median follow-up was 67.6 months. ET-only patients were less likely to have a comorbidity score of 0 (ET 75.4% versus RT 80.8%; <i>p</i> &lt; 0.001). Patients in the ET-only group had slightly larger tumors [ET 1.0&#xa0;cm (0.7–1.5&#xa0;cm) versus RT 0.9&#xa0;cm (0.6–1.3&#xa0;cm); <i>p</i> &lt; 0.001] and were less likely to have grade 3 tumors (ET 7.0% versus RT 8.4%; <i>p</i> &lt; 0.001). Unadjusted Kaplan–Meier analysis showed a higher 5&#xa0;year OS for RT-only patients compared with ET-only (RT 88.9% versus ET 85.8%; <i>p</i> &lt; 0.001). A similar trend was observed when stratified on the basis of age group (all log rank <i>p</i> &lt; 0.05). In the adjusted multivariable analysis, RT-only remained associated with a slightly better OS than ET-only [ET ref, RT hazards ratio 0.91 (95% CI 0.85–0.97)].</p> Conclusions <p>For older patients with early stage, ER+/HER2− breast cancer who undergo lumpectomy, patients receiving RT-only had a small survival advantage over patients receiving ET-only, which may or may not be clinically relevant. Further comparisons of RT-only versus ET-only may be warranted in this unique population.</p>

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Adjuvant Radiation vs Endocrine Therapy After Lumpectomy for Early-Stage Breast Cancer in Older Women: Analysis of Real-World Survival Outcomes

  • 期刊论文

  • 发表日期：

    2025年6月6日

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  • Tori C. Nierenberg,
  • Kerri-Anne Crowell,
  • Ton Wang,
  • Laura H. Rosenberger,
  • Gayle A. DiLalla,
  • Susan G. R. McDuff,
  • Gretchen Kimmick,
  • E. Shelley Hwang,
  • Jennifer K. Plichta

摘要

Background

We examined whether adjuvant radiation therapy (RT) monotherapy offers comparable overall survival (OS) to adjuvant endocrine therapy (ET) monotherapy following lumpectomy in women aged ≥ 65 years with favorable early stage breast cancer.

Patients and Methods

Patients aged ≥ 65 years, diagnosed with ER+/HER2−, cT1–2, N0 breast cancer, who underwent lumpectomy, were selected from the National Cancer Database (2004–2020). Kaplan–Meier estimates and Cox Proportional Hazards models evaluated OS differences across RT-only and ET-only groups.

Results

The final cohort included 91,505 patients, with 11.8% receiving RT alone and 29.5% receiving ET only. Median follow-up was 67.6 months. ET-only patients were less likely to have a comorbidity score of 0 (ET 75.4% versus RT 80.8%; p < 0.001). Patients in the ET-only group had slightly larger tumors [ET 1.0 cm (0.7–1.5 cm) versus RT 0.9 cm (0.6–1.3 cm); p < 0.001] and were less likely to have grade 3 tumors (ET 7.0% versus RT 8.4%; p < 0.001). Unadjusted Kaplan–Meier analysis showed a higher 5 year OS for RT-only patients compared with ET-only (RT 88.9% versus ET 85.8%; p < 0.001). A similar trend was observed when stratified on the basis of age group (all log rank p < 0.05). In the adjusted multivariable analysis, RT-only remained associated with a slightly better OS than ET-only [ET ref, RT hazards ratio 0.91 (95% CI 0.85–0.97)].

Conclusions

For older patients with early stage, ER+/HER2− breast cancer who undergo lumpectomy, patients receiving RT-only had a small survival advantage over patients receiving ET-only, which may or may not be clinically relevant. Further comparisons of RT-only versus ET-only may be warranted in this unique population.