Does Adjuvant Radiation Make Sense for Older Patients With Triple-Negative Breast Cancer?

Little is known about the potential benefits of adjuvant radiotherapy in older women diagnosed with triple-negative breast cancer (TNBC), but findings of a retrospective study reported at the 2015 Breast Cancer Symposium suggest that the approach may be worth considering for this population.

Sean Szeja, MD

Little is known about the potential benefits of adjuvant radiotherapy in older women diagnosed with triple-negative breast cancer (TNBC), but findings of a retrospective study reported at the 2015 Breast Cancer Symposium suggest that the approach may be worth considering for this population.

The study analyzed findings from the SEER database of 974 women diagnosed with TNBC from 2010-2011 aged ≥70 years treated with lumpectomy for their local, stage T1-2 TNBC with no lymph node involvement. Of the total, 68% of the women (n = 662) received adjuvant radiation therapy.

Survival for those who received lumpectomy plus radiotherapy was 98.2% 23 months after diagnosis, versus 85.6% for those who had lumpectomy alone. Breast cancer—related deaths were also more common in the lumpectomy-only group (6%) compared with 1% in the cohort who also had radiation.

When other factors were considered, such as age, tumor size, and other treatment descriptions, the use of adjuvant radiation was associated with an overall 6-fold decrease in any death, as well as death from breast cancer.

“When clinicians treat elderly patients with early-stage, triple-negative breast cancer, they can use these findings to make a more refined decision—with more information—to weigh the risks and benefits of radiation after lumpectomy,” explained lead author Sean Szeja, MD, radiation oncologist, University of Texas Medical Branch in Galveston, in an interview at the 2015 Breast Cancer Symposium. “The benefit from radiation is very substantial, and strong consideration should be given.”

The study authors noted, however, that the difference in survival observed between those who did and did not receive adjuvant radiotherapy for their TNBC could be explained by other factors, such as use of adjuvant chemotherapy.

Szeja acknowledged that whether to treat elderly patients with radiotherapy can be a complex decision, due to their age, weight, comorbidities, as well as social factors such as family support. “In addition to these other factors, the life expectancy of the patient is important, too.”

He said that in elderly patients with early-stage TNBC, researchers found that radiation as use was fairly widespread—approximately 68% of the time. While clinicians may have previously been recommended to hold off on radiation for this population, these findings suggest that the option should be considered more strongly, he added.

“This study suggests that adjuvant radiation therapy may benefit some elderly patients with breast cancer, but a prospective study will be needed to guide treatment decisions,” noted ASCO Expert Harold J. Burstein, MD, PhD, FASCO, in a statement accompanying release of the study. “When selecting treatments for elderly patients, we need to be particularly careful about weighing the benefits and risks.”

Szeja S, Hatch SS. Outcomes associated with adjuvant radiation after lumpectomy for elderly women with T1-2N0M0 triple-negative breast cancer: SEER analysis. Presented at: 2015 Breast Cancer Symposium; September 25-27; San Francisco, CA. Abstract 39.