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• W2972852012 abstract "The omission of radiation therapy (RT) in elderly women with stage 1 ER positive breast cancer receiving ET is an acceptable strategy based on randomized trial data. Less is known about the omission of ET +/- RT. This study examines treatment patterns and outcomes in this setting. We analyzed SEER-Medicare data for 13,321 women ages 66-85 diagnosed with stage I ER+ breast cancer from 2006-2012 who had continuous enrollment in Medicare Parts A, B, and D with claims through 2014. All underwent lumpectomy and had ≥2 year follow up. Patients were classified into 4 groups: 1) ET+RT (reference) 2) ET alone (ET), 3) RT alone (RT) and 4) Neither RT nor ET (NT). Second breast cancer events (SBCE) were captured using Chubak’s high-specificity algorithm for claims-based procedure and diagnosis codes and included recurrence (locoregional and distant) and second breast primaries. We used Chi-square tests for descriptive statistics, multivariable multinomial logistic regression to estimate odds (OR) of receiving a particular treatment, and multivariable competing-risks survival regression to estimate standardized hazard ratio (SHR) of SBCE, accounting for death as competing risk. Multivariable analyses included treatment, HER2, grade, T stage, axillary surgery, demographics, comorbidity (CI), registry, and diagnosis year. We set significance at p≤0.01. Most women underwent both treatments, with 44% undergoing ET+RT, 41% RT, 6.6% ET, and 8.6% NT but practice patterns varied over time: from 2007-2012, RT decreased from 49% to 30% (p<.01 2011-2012), whereas ET and ET+RT increased (ET: 5.4% to 9.6%; ET+RT: 38% to 51%). NT and ET increased while ET+RT decreased with increasing age. 6.7% of patients received chemotherapy. Compared to younger patients (66-69), older patients (80-85) were more likely to receive NT (OR=9.1), RT (OR=1.9), or ET (OR=8.6) compared to ET+RT (p<0.01). Those with higher CI were more likely to receive ET (OR=1.48, p=.004). Those with axillary surgery and increasing T stage were more likely to undergo ET+RT, all else equal. Overall, 3% of subjects had an SBCE (2.2% ET+RT, 3.0% RT, 3.2% ET, 7.0% NT). Mortality ranged from 4.3% ET+RT, 5.5% RT, and 10.3% ET to 11.1% for NT, with 10% of deaths attributed to breast cancer. Survival analysis indicated that relative to ET+RT, NT was associated with higher hazard of SBCE (SHR 4.5, p<0.0001), with a trend to higher SBCE with ET (SHR 2.1, p=0.04) and a weak trend with RT (SHR 1.7, p=0.1). The only other factors associated with SBCE were HER2 positivity (3.2% of entire cohort, SHR 2.79, p=0.01) and pT1c (vs. pTmi-b) (SHR 4.38, p<0.0001). The use of RT alone in older women with stage I ER positive disease is decreasing whereas the use of ET and ET+RT is increasing. NT is associated with higher SBCE in multivariable analysis. The risk of SBCE is higher following ET alone (vs. RT alone); though neither adjuvant monotherapy was significantly associated with a higher SBCE risk." @default.
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• W2972852012 date "2019-09-01" @default.
• W2972852012 modified "2023-10-16" @default.
• W2972852012 title "The Omission of Endocrine Therapy (ET) in Older Women with Stage I Estrogen-Receptor (ER)-Positive Breast Cancer Is Not Associated with a Higher Risk of Recurrence" @default.
• W2972852012 doi "https://doi.org/10.1016/j.ijrobp.2019.06.665" @default.
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