Skip to main content

Advertisement

SpringerLink
Log in

Accelerated partial breast irradiation using intensity-modulated radiotherapy technique compared to whole breast irradiation for patients aged 70 years or older: subgroup analysis from a randomized phase 3 trial

  • Clinical trial
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

The purpose of this study was to report the efficacy and the safety profile on the subset of selected early breast cancer (BC) patients aged 70 years or older from a single-center phase 3 trial comparing whole breast irradiation (WBI) to accelerated partial breast irradiation (APBI) using intensity-modulated radiation therapy technique. Between 2005 and 2013, 520 patients aged more than 40 years old were enrolled and randomly assigned to receive either WBI or APBI in a 1:1 ratio. Eligible patients were women with early BC (maximum diameter 2.5 cm) suitable for breast conserving surgery. This study is registered with ClinicalTrials.gov, NCT02104895. A total of 117 patients aged 70 years or more were analyzed (58 in the WBI arm, 59 in the APBI arm). At a median follow-up of 5-years (range 3.4–7.0), the ipsilateral breast tumor recurrence (IBTR) rate was 1.9 % in both groups. No significant difference between the two groups was identified (log-rank test p = 0.96). The 5-year disease-free survival (DFS) rates in the WBI group and APBI group were 6.1 and 1.9 %, respectively (p = 0.33). The APBI group presented significantly better results in terms of acute skin toxicity, considering both any grade (p = 0.0001) and grade 2 or higher (p = 0.0001). Our subgroup analyses showed a very low rate and no significant difference in terms of IBTR, using both WBI and APBI. A significant impact on patients compliance in terms of acute and early late toxicity was shown, which could translate in a consistent improvement of overall quality of life.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Kunkler I (2012) Radiotherapy issues in elderly breast cancer patients. Breast Care (Basel) 7:453–459

    Article  Google Scholar 

  2. Giordano SH (2012) Radiotherapy in older women with low-risk breast cancer: why did practice not change? J Clin Oncol 30:1577–1578

    Article  PubMed  Google Scholar 

  3. Biganzoli L, Wildiers H, Oakman C et al (2012) Management of elderly patients with breast cancer: updated recommendations of the International Society of Geriatric Oncology (SIOG) and European Society of Breast Cancer Specialists (EUSOMA). Lancet Oncol 13:148–160

    Article  Google Scholar 

  4. Hannoun-Levi JM, Courdi A, Marsiglia H et al (2003) Breast cancer in elderly women: is partial breast irradiation a good alternative? Breast Cancer Res Treat 81:243–251

    Article  CAS  PubMed  Google Scholar 

  5. Veronesi U, Luini A, Del Vecchio M et al (1993) Radiotherapy after breast-preserving surgery in women with localized cancer of the breast. N Engl J Med 328:1587–1591

    Article  CAS  PubMed  Google Scholar 

  6. Biganzoli L, Licitra S, Claudino W et al (2007) Clinical decision making in breast cancer: TAM and aromatase inhibitors for older patients—a jungle? Eur J Cancer 43:2270–2278

    Article  CAS  PubMed  Google Scholar 

  7. Muss HB, Tu D, Ingle JN et al (2008) Efficacy, toxicity, and quality of life in older women with early-stage breast cancer treated with letrozole or placebo after 5 years of tamoxifen: NCIC CTG intergroup trial MA.17. J Clin Oncol 26:1956–1964

    Article  CAS  PubMed  Google Scholar 

  8. Crivellari D, Sun Z, Coates AS et al (2008) Letrozole compared with tamoxifen for elderly patients with endocrine-responsive early breast cancer: the BIG 1-98 trial. J Clin Oncol 26:1972–1979

    Article  CAS  PubMed  Google Scholar 

  9. Goyal S, Kearney T, Haffty BG et al (2007) Current application and research directions for partial-breast irradiation. Oncology (Williston Park) 21:449–461

    Google Scholar 

  10. Sanders ME, Scroggins T, Ampil FL et al (2007) Accelerated partial breast irradiation in early-stage breast cancer. J Clin Oncol 25:996–1002

    Article  PubMed  Google Scholar 

  11. Vaidya JS, Wenz F, Bulsara M et al (2014) Risk-adapted targeted intraoperative radiotherapy versus whole-breast radiotherapy for breast cancer: 5-year results for local control and overall survival from the TARGIT-A randomised trial. Lancet 383:603–613

    Article  PubMed  Google Scholar 

  12. Genebes C, Chand ME, Gal J et al (2014) Accelerated partial breast irradiation in the elderly: 5-year results of high-dose rate multi-catheter brachytherapy. Radiat Oncol 9:115

    Article  PubMed Central  PubMed  Google Scholar 

  13. Khan AJ, Vicini FA, Beitsch P et al (2012) Local control, toxicity, and cosmesis in women > 70 years enrolled in the American Society of Breast Surgeons accelerated partial breast irradiation registry trial. Int J Radiat Oncol Biol Phys 84:323–330

    Article  PubMed  Google Scholar 

  14. Hannoun-Levi JM, Gourgou-Bourgade S, Belkacemi Y et al (2013) GERICO-03 phase II trial of accelerated and partial breast irradiation in elderly women: feasibility, reproducibility, and impact on functional status. Brachytherapy 12:285–292

    Article  PubMed  Google Scholar 

  15. Shah C, Antonucci JV, Wilkinson JB et al (2011) Twelve-year clinical outcomes and patterns of failure with accelerated partial breast irradiation versus whole-breast irradiation: results of a matched-pair analysis. Radiother Oncol 100:210–214

    Article  PubMed  Google Scholar 

  16. Shah C, Badiyan S, Ben Wilkinson J, Vicini F, Beitsch P, Keisch M, Arthur D, Lyden M (2013) Treatment efficacy with accelerated partial breast irradiation (APBI): final analysis of the American Society of Breast Surgeons MammoSite(®) breast brachytherapy registry trial. Ann Surg Oncol 20:3279–3285

    Article  PubMed  Google Scholar 

  17. Livi L, Meattini I, Marrazzo L et al (2015) Accelerated partial breast irradiation using intensity-modulated radiotherapy versus whole breast irradiation: 5-year survival analysis of a phase 3 randomised controlled trial. Eur J Cancer 51:451–463

    Article  PubMed  Google Scholar 

  18. Hammond ME, Hayes DF, Wolff AC et al (2010) American society of clinical oncology/college of american pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. J Oncol Pract 6:195–197

    Article  PubMed Central  PubMed  Google Scholar 

  19. DeCensi A, Guerrieri-Gonzaga A, Gandini S et al (2011) Prognostic significance of Ki-67 labeling index after short-term presurgical tamoxifen in women with ER-positive breast cancer. Ann Oncol 22:582–587

    Article  CAS  PubMed  Google Scholar 

  20. Munzone E, Botteri E, Sciandivasci A et al (2012) Prognostic value of Ki-67 labeling index in patients with node-negative, triple-negative breast cancer. Breast Cancer Res Treat 134:277–282

    Article  PubMed  Google Scholar 

  21. Goldhirsch A, Wood WC, Coates AS et al (2011) Strategies for subtypes—dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. Ann Oncol 22:1736–1747

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  22. Yanagawa M, Ikemot K, Kawauchi S et al (2012) Luminal A and luminal B (HER2 negative) subtypes of breast cancer consist of a mixture of tumors with different genotype. BMC Res Notes 5:376

    Article  PubMed Central  PubMed  Google Scholar 

  23. Cox JD, Stetz J, Pajak TF (1995) Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 31:1341–1346

    Article  CAS  PubMed  Google Scholar 

  24. Trombetta M, Julian TB, Kim Y et al (2009) The allegheny general modification of the Harvard breast cosmesis scale for the retreated breast. Oncology 23:954–956

    PubMed  Google Scholar 

  25. Mukesh MB, Barnett GC, Wilkinson JS et al (2013) Randomized controlled trial of intensity-modulated radiotherapy for early breast cancer: 5-year results confirm superior overall cosmesis. J Clin Oncol 31:4488–4495

    Article  PubMed  Google Scholar 

  26. Belkacemi Y, Bourgier C, Kramar A et al (2013) SHARE: a French multicenter phase III trial comparing accelerated partial irradiation versus standard or hypofractionated whole breast irradiation in breast cancer patients at low risk of local recurrence. Clin Adv Hematol Oncol 11:76–83

    PubMed  Google Scholar 

  27. Dodwell DJ, Dyker K, Brown J et al (2005) A randomised study of whole-breast vs tumour-bed irradiation after local excision and axillary dissection for early breast cancer. Clin Oncol (R Coll Radiol) 17:618–622

    Article  CAS  Google Scholar 

  28. Polgár C, Van Limbergen E, Pötter R et al (2010) Patient selection for accelerated partial-breast irradiation (APBI) after breast-conserving surgery: recommendations of the Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) breast cancer working group based on clinical evidence (2009). Radiother Oncol 94:264–273

    Article  PubMed  Google Scholar 

  29. Smith BD, Arthur DW, Buchholz TA et al (2009) Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO). Int J Radiat Oncol Biol Phys 74:987–1001

    Article  PubMed  Google Scholar 

  30. Veronesi U, Orecchia R, Maisonneuve P et al (2013) Intraoperative radiotherapy versus external radiotherapy for early breast cancer (ELIOT): a randomised controlled equivalence trial. Lancet Oncol 14:1269–1277

    Article  PubMed  Google Scholar 

  31. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), Darby S, McGale P, Correa C, Taylor C, Arriagada R, Clarke M, Cutter D, Davies C, Ewertz M, Godwin J, Gray R, Pierce L, Whelan T, Wang Y, Peto R (2011) Effect of radiotherapy after breast conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet 378:1707–1716

    Article  Google Scholar 

  32. Fisher B, Bryant J, Dignam JJ et al (2002) Tamoxifen, radiation therapy, or both for prevention of ipsilateral breast tumor recurrence after lumpectomy in women with invasive breast cancers of one centimeter or less. J Clin Oncol 20:4141–4149

    Article  CAS  PubMed  Google Scholar 

  33. Fyles AW, McCready DR, Manchul LA et al (2004) Tamoxifen with or without breast irradiation in women 50 years of age or older with early breast cancer. N Engl J Med 351:963–970

    Article  CAS  PubMed  Google Scholar 

  34. Hughes KS, Schnaper LA, Bellon JR et al (2013) Lumpectomy plus tamoxifen with or without irradiation in women age 70 years or older with early breast cancer: long-term follow-up of CALGB 9343. J Clin Oncol 31:2382–2387

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  35. Kunkler IH, Williams LJ, Jack WJ et al (2015) Breast-conserving surgery with or without irradiation in women aged 65 years or older with early breast cancer (PRIME II): a randomised controlled trial. Lancet Oncol 16:266–273

    Article  PubMed  Google Scholar 

  36. Murphy CC, Bartholomew LK, Carpentier MY et al (2012) Adherence to adjuvant hormonal therapy among breast cancer survivors in clinical practice: a systematic review. Breast Cancer Res Treat 134:459–478

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  37. Blamey RW, Bates T, Chetty U et al (2013) Radiotherapy or tamoxifen after conserving surgery for breast cancers of excellent prognosis: British Association of Surgical Oncology (BASO) II trial. Eur J Cancer 49:2294–2302

    Article  CAS  PubMed  Google Scholar 

  38. Kaidar-Person O, Kuten A, Walker GA (2013) Should radiotherapy be omitted in women age 70 years or older with early breast cancer? J Clin Oncol 31:4569

    Article  PubMed  Google Scholar 

  39. Haviland JS, Owen JR, Dewar JA et al (2013) The UK Standardisation of Breast Radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10-year follow-up results of two randomised controlled trials. Lancet Oncol 14:1086–1094

    Article  PubMed  Google Scholar 

  40. Welzel G, Boch A, Sperk E et al (2013) Radiation-related quality of life parameters after targeted intraoperative radiotherapy versus whole breast radiotherapy in patients with breast cancer: results from the randomized phase III trial TARGIT-A. Radiat Oncol 8:9

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

Partial data of present study have been presented during 3rd European Society for Radiotherapy and Oncology (ESTRO) Forum, 24–28 April 2015, Barcelona. We would like to thank Mrs. Chiara Rocha for English revision of this manuscript.

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy

    Icro Meattini, Lucia Di Brina, Monica Mangoni, Fiammetta Meacci, Giulio Francolini, Isacco Desideri, Carla De Luca Cardillo, Vieri Scotti, Ilaria Francesca Furfaro, Daniela Greto, Pierluigi Bonomo & Lorenzo Livi

  2. Molecular and Nutritional Epidemiology Unit, ISPO (Cancer Research and Prevention Institute), Florence, Italy

    Calogero Saieva & Benedetta Bendinelli

  3. Medical Physics Unit, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

    Livia Marrazzo & Stefania Pallotta

  4. Radiotehrapy Unit, Azienda Sanitaria 10, Florence, Italy

    Francesca Rossi

  5. Department of Surgery, University of Florence, Florence, Italy

    Donato Casella, Marco Bernini, Luis Sanchez, Lorenzo Orzalesi & Roberta Simoncini

  6. Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

    Jacopo Nori

  7. Division of Pathological Anatomy, University of Florence, Florence, Italy

    Simonetta Bianchi

Authors
  1. Icro Meattini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Calogero Saieva
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Livia Marrazzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lucia Di Brina
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stefania Pallotta
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Monica Mangoni
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Fiammetta Meacci
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Benedetta Bendinelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Giulio Francolini
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Isacco Desideri
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Carla De Luca Cardillo
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Vieri Scotti
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Ilaria Francesca Furfaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Francesca Rossi
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Daniela Greto
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Pierluigi Bonomo
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Donato Casella
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Marco Bernini
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Luis Sanchez
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Lorenzo Orzalesi
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Roberta Simoncini
    View author publications

    You can also search for this author in PubMed Google Scholar

  22. Jacopo Nori
    View author publications

    You can also search for this author in PubMed Google Scholar

  23. Simonetta Bianchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  24. Lorenzo Livi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Icro Meattini.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Meattini, I., Saieva, C., Marrazzo, L. et al. Accelerated partial breast irradiation using intensity-modulated radiotherapy technique compared to whole breast irradiation for patients aged 70 years or older: subgroup analysis from a randomized phase 3 trial. Breast Cancer Res Treat 153, 539–547 (2015). https://doi.org/10.1007/s10549-015-3565-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-015-3565-2

Keywords

Search

Navigation