De-escalation of radiation therapy in patients with stage I, node-negative, HER2-positive breast cancer

Abstract In the modern era, highly effective anti-HER2 therapy is associated with low local-regional recurrence (LRR) rates for early-stage HER2+ breast cancer raising the question of whether local therapy de-escalation by radiation omission is possible in patients with small-node negative tumors tr...

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Autores principales:	Jose G. Bazan, Sachin R. Jhawar, Daniel Stover, Ko Un Park, Sasha Beyer, Erin Healy, Julia R. White
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/9924a15756c443988ef0afef40bd20e6
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spelling	oai:doaj.org-article:9924a15756c443988ef0afef40bd20e62021-12-02T16:36:08ZDe-escalation of radiation therapy in patients with stage I, node-negative, HER2-positive breast cancer10.1038/s41523-021-00242-82374-4677https://doaj.org/article/9924a15756c443988ef0afef40bd20e62021-03-01T00:00:00Zhttps://doi.org/10.1038/s41523-021-00242-8https://doaj.org/toc/2374-4677Abstract In the modern era, highly effective anti-HER2 therapy is associated with low local-regional recurrence (LRR) rates for early-stage HER2+ breast cancer raising the question of whether local therapy de-escalation by radiation omission is possible in patients with small-node negative tumors treated with lumpectomy. To evaluate existing data on radiation omission, we used the National Cancer Database (NCDB) to test the hypothesis that RT omission results in equivalent overall survival (OS) in stage 1 (T1N0) HER2+ breast cancer. We excluded patients that received neoadjuvant systemic therapy. We stratified the cohort by receipt of adjuvant radiation. We identified 6897 patients (6388 RT; 509 no RT). Patients that did not receive radiation tended to be ≥70 years-old (odds ratio [OR] = 3.69, 95% CI: 3.02–4.51, p < 0.0001), to have ≥1 comorbidity (OR = 1.33, 95% CI: 1.06–1.68, p = 0.0154), to be Hispanic (OR = 1.49, 95% CI: 1.00–2.22, p = 0.049), and to live in lower income areas (OR = 1.32, 95% CI: 1.07–1.64, p = 0.0266). Radiation omission was associated with a 3.67-fold (95% CI: 2.23–6.02, p < 0.0001) increased risk of death. While other selection biases that influence radiation omission likely persist, these data should give caution to radiation omission in T1N0 HER2+ breast cancer.Jose G. BazanSachin R. JhawarDaniel StoverKo Un ParkSasha BeyerErin HealyJulia R. WhiteNature PortfolioarticleNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENnpj Breast Cancer, Vol 7, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Jose G. Bazan Sachin R. Jhawar Daniel Stover Ko Un Park Sasha Beyer Erin Healy Julia R. White De-escalation of radiation therapy in patients with stage I, node-negative, HER2-positive breast cancer
description	Abstract In the modern era, highly effective anti-HER2 therapy is associated with low local-regional recurrence (LRR) rates for early-stage HER2+ breast cancer raising the question of whether local therapy de-escalation by radiation omission is possible in patients with small-node negative tumors treated with lumpectomy. To evaluate existing data on radiation omission, we used the National Cancer Database (NCDB) to test the hypothesis that RT omission results in equivalent overall survival (OS) in stage 1 (T1N0) HER2+ breast cancer. We excluded patients that received neoadjuvant systemic therapy. We stratified the cohort by receipt of adjuvant radiation. We identified 6897 patients (6388 RT; 509 no RT). Patients that did not receive radiation tended to be ≥70 years-old (odds ratio [OR] = 3.69, 95% CI: 3.02–4.51, p < 0.0001), to have ≥1 comorbidity (OR = 1.33, 95% CI: 1.06–1.68, p = 0.0154), to be Hispanic (OR = 1.49, 95% CI: 1.00–2.22, p = 0.049), and to live in lower income areas (OR = 1.32, 95% CI: 1.07–1.64, p = 0.0266). Radiation omission was associated with a 3.67-fold (95% CI: 2.23–6.02, p < 0.0001) increased risk of death. While other selection biases that influence radiation omission likely persist, these data should give caution to radiation omission in T1N0 HER2+ breast cancer.
format	article
author	Jose G. Bazan Sachin R. Jhawar Daniel Stover Ko Un Park Sasha Beyer Erin Healy Julia R. White
author_facet	Jose G. Bazan Sachin R. Jhawar Daniel Stover Ko Un Park Sasha Beyer Erin Healy Julia R. White
author_sort	Jose G. Bazan
title	De-escalation of radiation therapy in patients with stage I, node-negative, HER2-positive breast cancer
title_short	De-escalation of radiation therapy in patients with stage I, node-negative, HER2-positive breast cancer
title_full	De-escalation of radiation therapy in patients with stage I, node-negative, HER2-positive breast cancer
title_fullStr	De-escalation of radiation therapy in patients with stage I, node-negative, HER2-positive breast cancer
title_full_unstemmed	De-escalation of radiation therapy in patients with stage I, node-negative, HER2-positive breast cancer
title_sort	de-escalation of radiation therapy in patients with stage i, node-negative, her2-positive breast cancer
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/9924a15756c443988ef0afef40bd20e6
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De-escalation of radiation therapy in patients with stage I, node-negative, HER2-positive breast cancer

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