January 16, 2015
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Many older patients with early-stage breast cancer receive radiation despite limited effectiveness

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About two-thirds of elderly women with early-stage breast cancers undergo radiation, even though clinical trial data support omission of that treatment modality, according to study results.

“It’s important to improve patient and doctor communication to ensure that the right patients are getting the right treatment at the right time,” Rachel Blitzblau, MD, PhD, assistant professor of radiation oncology at Duke Cancer Institute, told HemOnc Today. “As we work toward more efficient and evidence-based medical practice in all medical specialties, we will need to understand what processes may be needed to spur change.”

Results from a large randomized trial — conducted by the Cancer and Leukemia Group B (CALGB) and published in 2004 — showed the addition of radiation to lumpectomy and adjuvant tamoxifen failed to extend survival among elderly women with early-stage hormone receptor-positive breast cancer.

Those who underwent radiation demonstrated lower rates of 5-year recurrence (1% vs. 4%), but the researchers in that study suggested the absolute difference of 3% was small enough to warrant consideration of lumpectomy and tamoxifen alone in this patient population.

Despite those findings, many doctors administer radiation to this patient population, but the extent to which this occurs had not been established, according to background information in the study.

Blitzblau and colleagues used the SEER database to identify 40,583 women aged ≥70 years who underwent lumpectomy between 2000 and 2009. All women in the cohort had stage I ER-positive and/or PR-positive breast cancer.

Results showed that 68.6% of patients treated between 2000 and 2004 — prior to publication of the CALGB study results — received some type of radiation therapy. Between 2005 and 2009, the percentage declined to 61.7% (P<.001). During the latter time period, fewer patients underwent standard whole breast radiation and more underwent a short course of focused radiation.

Researchers reported significant reductions in frequency of radiotherapy delivery over time among subsets of patients grouped by age, tumor grade and tumor size (P<.001 for all).

However, the fact three out of five women in this population continue to undergo some type of radiation treatment shows publication of the [CALGB] trial results had only a very small impact on practice, the researchers wrote.

“The onus is on physicians to critically analyze data to shape our treatment recommendations for patients, weighing the potential toxicities of treatment against clinical benefit,” Blitzblau and colleagues wrote. –by Anthony SanFilippo

Rachel Blitzblau, MD, PhD, can be reached at Department of Radiation Oncology, Duke University, DUMC 3085, Durham, NC 27710.

Disclosure: The researchers report no relevant financial disclosures.