Impact of Loco-Regional Undertreatment in Elderly Patients with Early Breast Cancer (Protocol Yameka-09sdlt); Multi-Centric Retrospective Cohort Study

Elderly breast cancer patients are generally excluded from clinical trials and non-standard treatments are administered more in this group of patients. Aim of the study is to assess the impact of non-standard locoregional treatment on survival in elderly patients with clinically early stage breast cancer. Patients over 70 years of age operated for a unilateral, early stage breast cancer between 1998 and 2009 were retrospectively included in the study. Patient and tumor characteristics were recorded. Adjuvant treatments, last date of follow-up and recurrences and/or death were recorded. Treatments without radiotherapy after breast conserving therapy, without sentinel lymph node biopsy or axillary dissection, without axillary dissection or axillary radiotherapy in case of a positive sentinel lymph node and without radiotherapy in the presence of ≥ 4 positive lymph nodes were regarded as loco-regional under-treatment. Disease-free, breast cancer-specific and overall survival of patients who received standard and non-standart loco-regional treatments were compared. 384 patients with a median age of 74 were included in the study. Median tumor size was 25 mm. Non-standard loco-regional treatment was applied in 90 (23.4%) patients. Most commonly omitted was axillary treatment. Patients with 3 or more associated diseases significantly received less standard loco-regional treatment. Median follow-up period was 35 months and, during follow-up, 10.4% of patients had recurrence whereas 13% of patients died. Although disease-free survival were similar in both groups, overall and breast cancer-specific survivals were significantly less in those who received non-standart locoregional treatment. As number of associated diseases reaches three or more, there was a strong tendency to administer less standard locoregional treatment. Most commonly, patients did not undergo axillary staging or treatment. Although loco-regional under-treatment resulted poorer overall and breast cancer-specific survival, disease free survival was not different in those elderly early stage breast cancer patients who received adequate treatment. Short follow-up time should be kept in mind while evaluating the results of the current study.