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Research ArticleClinical Studies

Impact of CALGB 9343 Trial and Sociodemographic Variation on Patterns of Adjuvant Radiation Therapy Practice for Elderly Women (≥70 Years) with Stage I, Estrogen Receptor-positive Breast Cancer: Analysis of the National Cancer Data Base

QUYEN D. CHU, MEIJIAO ZHOU, KAELEN L. MEDEIROS, PRAKASH PEDDI and XIAO CHENG WU
Anticancer Research October 2017, 37 (10) 5585-5594;
QUYEN D. CHU
1Department of Surgery, Louisiana State University Health Sciences Center in Shreveport, Shreveport, Louisiana, LA, U.S.A.
2Feist-Weiller Cancer Center, Shreveport, LA, U.S.A.
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MEIJIAO ZHOU
3School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, U.S.A.
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KAELEN L. MEDEIROS
3School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, U.S.A.
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PRAKASH PEDDI
2Feist-Weiller Cancer Center, Shreveport, LA, U.S.A.
4Department of Medicine, Louisiana State University Health Sciences Center in Shreveport, Shreveport, Louisiana, LA, U.S.A.
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  • For correspondence: ppeddi@lsuhsc.edu
XIAO CHENG WU
3School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, U.S.A.
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Abstract

Background: The Cancer and Leukemia Group B (CALGB) 9343 trial demonstrated that adjuvant radiation therapy (RT) can be omitted in women 70 years or older, with small (≤2 cm), negative lymph nodes, estrogen receptor (ER)-positive breast cancer. We examined whether RT usage following the CALGB publication had decreased over time and evaluated sociodemographic and clinical factors associated with RT omission. Materials and Methods: From the National Cancer Data Base, we analyzed a cohort of 120,308 women aged 70 years or older with stage I, ER-positive breast cancer who underwent lumpectomy. Patients were classified into two groups based on the time of CALGB 9343 publication: (i) pre-CALGB (up to 2004), and (ii) post-CALGB (2005-2012). Clinicopathological and sociodemographic variables were compared between pre- and post-CALGB groups. Chi-square and multivariable logistic regression were employed, with the omission of adjuvant RT as the primary outcome in the regression analysis. Results: Radiation therapy usage decreased by 4.1% after CALGB publication (on average 71.6% pre-CALGB vs. 67.5% post-CALGB; p<0.0001). Almost one-third of women aged ≥85 years received RT in the post-CALGB group. In a multivariable model, the variables significantly associated with increased odds for omission of RT in the post-CALGB group were: advanced age, African-American, increased great circle distance, therapy under academic research program, residents of East South-Central region, living in a rural population <2,500 not adjacent to a metropolitan area, low income level, Medicaid recipients, high comorbidity index, small tumor, well-differentiated histology, residual tumor, and lack of receipt of chemotherapy and anti-hormonal therapy. Conclusion: During the study period, the CALGB trial publication had a minimal impact on the rate of adjuvant RT use among elderly women with small, ER-positive breast cancers. Significant variation in RT usage existed across sociodemographic strata.

  • Elderly
  • breast cancer
  • hormone-positive breast cancer
  • ER+
  • stage I breast cancer
  • radiation therapy
  • small breast cancer
  • adherence
  • Received August 11, 2017.
  • Revision received September 8, 2017.
  • Accepted September 13, 2017.
  • Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved
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Anticancer Research: 37 (10)
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October 2017
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Impact of CALGB 9343 Trial and Sociodemographic Variation on Patterns of Adjuvant Radiation Therapy Practice for Elderly Women (≥70 Years) with Stage I, Estrogen Receptor-positive Breast Cancer: Analysis of the National Cancer Data Base
QUYEN D. CHU, MEIJIAO ZHOU, KAELEN L. MEDEIROS, PRAKASH PEDDI, XIAO CHENG WU
Anticancer Research Oct 2017, 37 (10) 5585-5594;

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Impact of CALGB 9343 Trial and Sociodemographic Variation on Patterns of Adjuvant Radiation Therapy Practice for Elderly Women (≥70 Years) with Stage I, Estrogen Receptor-positive Breast Cancer: Analysis of the National Cancer Data Base
QUYEN D. CHU, MEIJIAO ZHOU, KAELEN L. MEDEIROS, PRAKASH PEDDI, XIAO CHENG WU
Anticancer Research Oct 2017, 37 (10) 5585-5594;
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Keywords

  • Elderly
  • Breast cancer
  • hormone-positive breast cancer
  • ER+
  • stage I breast cancer
  • radiation therapy
  • small breast cancer
  • adherence
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