Comparing hormone therapy and radiation after breast conserving surgery for older patients with early-stage breast cancer

This study compared the survival rates for older patients with early-stage breast cancer (BC) receiving hormone therapy (HT), radiation (RT), both or none after breast-conserving surgery (BCS).

The data showed that RT and HT in combination and RT alone may lead to higher survival expectancy than HT alone.

Some forms of BC grow in response to the female hormone estrogen. These types of BC are called estrogen receptor-positive (ER-positive). For some, BCS is necessary. This means removal of the tumor only, with the preservation of the breast. Afterward, patients are typically treated with HT to limit hormone-triggered growth.

In older patients, the standard treatment is HT in combination with RT. Studies have shown that almost all patients reach the 5-year survival mark. According to studies, there are critical aspects, especially for older patients. RT can be very aggressive and impact the patients’ body heavily. HT is conducted daily for 5-6 weeks. This requires a lot of time, effort, and attention which has shown to be difficult for older patients. The goal is to adjust the treatment and make it more patient-friendly while maintaining good overall survival (OS) rates.

There is not yet enough data observing the OS rates and effectiveness for HT and RT in combination, RT alone and HT alone as a treatment after BCS in older patients with ER-positive BC.

The study observed data of 130,194 women aged 65 years or older. All patients had early-stage ER-positive BC. All of the women had received BCS and either RT alone (14%), HT alone (18.1%), both HT and RT (55.1%), or none (12.8%) as treatment within 6 months after surgery. The main measure was OS for each group after 5 and 10 years.

RT and HT as a treatment showed the best OS after 5 years (90%) and after 10 years (64.3%). The shortest OS was shown in the group of no treatment: 71.6% after 5 years and 38% after 10 years. Patients receiving RT alone had a significantly better OS rate at 5 years (84.2% vs 78.7%) and at 10 years (54.9% vs 44.5%) than patients receiving HT alone. 

The authors recommend RT and HT or RT alone as a treatment after BCS with improved survival rates for older women with ER-positive BC.

The data in this study stems from a US-only database. The authors do not discuss in detail the additional medications that might have the outcome for the patients.