A new analysis of over 3,000 elderly patients has demonstrated that radiotherapy significantly extends survival in early-stage triple negative breast cancer (TNBC), offering crucial evidence for treatment decisions in an often-underrepresented patient population.
The study, published in Frontiers in Medicine, analyzed data from the Surveillance, Epidemiology, and End Results (SEER) database, examining 3,024 patients aged 70 and older with T1-2N0-1M0 TNBC. Of these, 2,045 patients (67.6%) received radiotherapy while 979 (32.4%) did not.
Significant Survival Benefits
The research revealed compelling survival advantages for patients receiving radiotherapy. Overall survival improved significantly with a hazard ratio of 0.69 (95% CI = 0.60–0.79; P < .001), while breast cancer-specific survival showed similar benefits (HR = 0.64; 95% CI = 0.51–0.80; P = 0.001).
Particularly notable were the results among patients who underwent breast-conserving surgery (BCS). This group, comprising 1,945 patients, demonstrated markedly improved overall survival (HR = 0.68; 95% CI = 0.58–0.79; P < 0.001) and breast cancer-specific survival (HR = 0.65; 95% CI = 0.51–0.84; P = 0.005) when treated with radiotherapy.
Risk-Stratified Outcomes
The study's findings were particularly pronounced in specific risk categories. Intermediate-risk patients showed substantial benefits in both overall survival (HR = 0.49) and breast cancer-specific survival (HR = 0.40). High-risk patients also demonstrated significant improvements, though the low-risk group showed no statistically significant benefit.
Addressing the Age Gap in Clinical Research
This research addresses a critical void in clinical evidence for elderly breast cancer patients. Despite individuals over 70 representing 30% of all breast cancer cases, they constitute only 3% of clinical trial participants. This underrepresentation has historically complicated treatment decisions, particularly given the prevalence of comorbidities in this age group.
Treatment Patterns and Demographics
The radiotherapy group showed distinct characteristics, with younger patients more likely to receive treatment. Only 8.9% of patients aged ≥85 years received radiotherapy, compared to 21.5% in the non-radiotherapy group. Additionally, patients receiving radiotherapy were more likely to undergo chemotherapy (47.6%) compared to those who did not receive radiation (31.5%).
Clinical Implications
The findings provide valuable guidance for clinicians treating elderly TNBC patients, particularly those considering breast-conserving surgery. The study's development of a nomogram for patient evaluation offers an additional tool for identifying suitable candidates for radiotherapy, potentially improving treatment decision-making for this vulnerable population.
