TY - JOUR
T1 - Effects of radiotherapy in early-stage, low-recurrence risk, hormone-sensitive breast cancer
AU - CISNET-BOLD Collaborative Group
AU - Jayasekera, Jinani
AU - Schechter, Clyde B.
AU - Sparano, Joseph A.
AU - Jagsi, Reshma
AU - White, Julia
AU - Chapman, Judith Anne W.
AU - Whelan, Timothy
AU - Anderson, Stewart J.
AU - Fyles, Anthony W.
AU - Sauerbrei, Willi
AU - Zellars, Richard C.
AU - Li, Yisheng
AU - Song, Juhee
AU - Huang, Xuelin
AU - Julian, Thomas B.
AU - Luta, George
AU - Berry, Donald A.
AU - Feuer, Eric J.
AU - Mandelblatt, Jeanne
N1 - Publisher Copyright:
© The Author(s) 2018.
PY - 2018/12/1
Y1 - 2018/12/1
N2 - Background: Radiotherapy after breast conservation has become the standard of care. Prior meta-analyses on effects of radiotherapy predated availability of gene expression profiling (GEP) to assess recurrence risk and/or did not include all relevant outcomes. This analysis used GEP information with pooled individual-level data to evaluate the impact of omitting radiotherapy on recurrence and mortality. Methods: We considered trials that evaluated or administered radiotherapy after lumpectomy in women with low-risk breast cancer. Women included had undergone lumpectomy and were treated with hormonal therapy for stage I, ERþ and/or PRþ, HER2 breast cancer with Oncotype scores no greater than 18. Recurrence-free interval (RFI), type of RFI (locoregional or distant), and breast cancer-specific and overall survival were compared between no radiotherapy and radiotherapy using adjusted Cox models. All statistical tests were two-sided. Results: The final sample included 1778 women from seven trials. Omission of radiotherapy was associated with an overall adjusted hazard ratio of 2.59 (95% confidence interval [CI] ¼ 1.38 to 4.89, P ¼ .003) for RFI. There was a statistically significant increase in any first locoregional recurrence (P ¼ .001), but not distant recurrence events (P ¼ .90), or breast cancer-specific (P ¼ .85) or overall survival (P ¼ .61). Five-year RFI rate was high (93.5% for no radiotherapy vs 97.9% for radiotherapy; absolute reduction ¼ 4.4%, 95% CI ¼ 0.7% to 8.1%, P ¼ .03). The effects of radiotherapy varied across subgroups, with lower RFI rates for those with Oncotype scores of less than 11 (vs 11-18), older (vs younger), and ERþ/PRþ status (vs other). Conclusions: Omission of radiotherapy in hormone-sensitive patients with low recurrence risk may lead to a modest increase in locoregional recurrence event rates, but does not appear to increase the rate of distant recurrence or death.
AB - Background: Radiotherapy after breast conservation has become the standard of care. Prior meta-analyses on effects of radiotherapy predated availability of gene expression profiling (GEP) to assess recurrence risk and/or did not include all relevant outcomes. This analysis used GEP information with pooled individual-level data to evaluate the impact of omitting radiotherapy on recurrence and mortality. Methods: We considered trials that evaluated or administered radiotherapy after lumpectomy in women with low-risk breast cancer. Women included had undergone lumpectomy and were treated with hormonal therapy for stage I, ERþ and/or PRþ, HER2 breast cancer with Oncotype scores no greater than 18. Recurrence-free interval (RFI), type of RFI (locoregional or distant), and breast cancer-specific and overall survival were compared between no radiotherapy and radiotherapy using adjusted Cox models. All statistical tests were two-sided. Results: The final sample included 1778 women from seven trials. Omission of radiotherapy was associated with an overall adjusted hazard ratio of 2.59 (95% confidence interval [CI] ¼ 1.38 to 4.89, P ¼ .003) for RFI. There was a statistically significant increase in any first locoregional recurrence (P ¼ .001), but not distant recurrence events (P ¼ .90), or breast cancer-specific (P ¼ .85) or overall survival (P ¼ .61). Five-year RFI rate was high (93.5% for no radiotherapy vs 97.9% for radiotherapy; absolute reduction ¼ 4.4%, 95% CI ¼ 0.7% to 8.1%, P ¼ .03). The effects of radiotherapy varied across subgroups, with lower RFI rates for those with Oncotype scores of less than 11 (vs 11-18), older (vs younger), and ERþ/PRþ status (vs other). Conclusions: Omission of radiotherapy in hormone-sensitive patients with low recurrence risk may lead to a modest increase in locoregional recurrence event rates, but does not appear to increase the rate of distant recurrence or death.
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U2 - 10.1093/jnci/djy128
DO - 10.1093/jnci/djy128
M3 - Article
C2 - 30239794
AN - SCOPUS:85058882310
SN - 0027-8874
VL - 110
JO - Journal of the National Cancer Institute
JF - Journal of the National Cancer Institute
IS - 12
M1 - djy128
ER -