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De-Implementation of Axillary Staging and Radiotherapy in Low-Risk Breast Cancer Patients Aged 70–79 Years from Six Italian Cancer Institutes

In women aged ≥70 with low-risk breast cancer (BrC), some major international guidelines recommend against sentinel lymph node biopsy (for example, those from the Society of Surgical Oncology, U.S.) and post-lumpectomy radiotherapy (for example, those from the National Comprehensive Cancer Network,...

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Autores principales: Bucchi, Lauro, Ravaioli, Alessandra, Dal Maso, Luigino, Falcini, Fabio, Mangone, Lucia, Massarut, Samuele, Schirosi, Laura, Crispo, Anna, Vici, Patrizia, Franceschi, Silvia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10137373/
https://www.ncbi.nlm.nih.gov/pubmed/37185431
http://dx.doi.org/10.3390/curroncol30040318
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author Bucchi, Lauro
Ravaioli, Alessandra
Dal Maso, Luigino
Falcini, Fabio
Mangone, Lucia
Massarut, Samuele
Schirosi, Laura
Crispo, Anna
Vici, Patrizia
Franceschi, Silvia
author_facet Bucchi, Lauro
Ravaioli, Alessandra
Dal Maso, Luigino
Falcini, Fabio
Mangone, Lucia
Massarut, Samuele
Schirosi, Laura
Crispo, Anna
Vici, Patrizia
Franceschi, Silvia
author_sort Bucchi, Lauro
collection PubMed
description In women aged ≥70 with low-risk breast cancer (BrC), some major international guidelines recommend against sentinel lymph node biopsy (for example, those from the Society of Surgical Oncology, U.S.) and post-lumpectomy radiotherapy (for example, those from the National Comprehensive Cancer Network, U.S.). We assessed the frequency of both procedures in six National Cancer Institutes (IRCCSs) in the North, the Centre, and the South of Italy. Data on tumour characteristics and treatment were obtained from each centre. Patients aged 70–79 years diagnosed with a pT1–pT2, clinically axillary lymph node-negative, oestrogen and/or progesterone receptor-positive, and human epidermal growth factor receptor 2-negative BrC between 2015 and 2020 were eligible for the study. Factors associated with the omission of the two procedures were evaluated using binary penalised logistic regression models. Axillary staging was omitted in 33/1000 (3.3%) women. After simultaneous adjustment for the centre of treatment and all other key variables, axillary staging was omitted more often in 2015–2016 vs. 2017–2020 (odds ratio (OR): 2.7; 95% CI: 1.0–7.5), in women aged 75–79 vs. 70–74 years (OR: 2.3; 95% CI: 1.1–4.9), and in those who had mastectomy vs. breast-conserving surgery (OR: 3.3; 95% CI: 1.2–9.0). The higher the histological grade was, the less frequent were the omissions (OR for grade 3 vs. grade 1: 0.2; 95% CI: 0.0–0.7). Post-lumpectomy radiotherapy was omitted in 56/651 (8.6%) women with no significant association with age, period, tumour stage, and tumour grade. In conclusion, the omission of axillary staging and post-lumpectomy radiotherapy in low-risk older BrC patients was rare in the Italian IRCCSs. Although women included in the study cannot be considered a nationally representative sample of BrC patients in Italy, our findings can serve as a baseline to monitor the impact of future guidelines. To do that, the recording and storage of hospital-based information should be improved.
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spelling pubmed-101373732023-04-28 De-Implementation of Axillary Staging and Radiotherapy in Low-Risk Breast Cancer Patients Aged 70–79 Years from Six Italian Cancer Institutes Bucchi, Lauro Ravaioli, Alessandra Dal Maso, Luigino Falcini, Fabio Mangone, Lucia Massarut, Samuele Schirosi, Laura Crispo, Anna Vici, Patrizia Franceschi, Silvia Curr Oncol Communication In women aged ≥70 with low-risk breast cancer (BrC), some major international guidelines recommend against sentinel lymph node biopsy (for example, those from the Society of Surgical Oncology, U.S.) and post-lumpectomy radiotherapy (for example, those from the National Comprehensive Cancer Network, U.S.). We assessed the frequency of both procedures in six National Cancer Institutes (IRCCSs) in the North, the Centre, and the South of Italy. Data on tumour characteristics and treatment were obtained from each centre. Patients aged 70–79 years diagnosed with a pT1–pT2, clinically axillary lymph node-negative, oestrogen and/or progesterone receptor-positive, and human epidermal growth factor receptor 2-negative BrC between 2015 and 2020 were eligible for the study. Factors associated with the omission of the two procedures were evaluated using binary penalised logistic regression models. Axillary staging was omitted in 33/1000 (3.3%) women. After simultaneous adjustment for the centre of treatment and all other key variables, axillary staging was omitted more often in 2015–2016 vs. 2017–2020 (odds ratio (OR): 2.7; 95% CI: 1.0–7.5), in women aged 75–79 vs. 70–74 years (OR: 2.3; 95% CI: 1.1–4.9), and in those who had mastectomy vs. breast-conserving surgery (OR: 3.3; 95% CI: 1.2–9.0). The higher the histological grade was, the less frequent were the omissions (OR for grade 3 vs. grade 1: 0.2; 95% CI: 0.0–0.7). Post-lumpectomy radiotherapy was omitted in 56/651 (8.6%) women with no significant association with age, period, tumour stage, and tumour grade. In conclusion, the omission of axillary staging and post-lumpectomy radiotherapy in low-risk older BrC patients was rare in the Italian IRCCSs. Although women included in the study cannot be considered a nationally representative sample of BrC patients in Italy, our findings can serve as a baseline to monitor the impact of future guidelines. To do that, the recording and storage of hospital-based information should be improved. MDPI 2023-04-13 /pmc/articles/PMC10137373/ /pubmed/37185431 http://dx.doi.org/10.3390/curroncol30040318 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Communication
Bucchi, Lauro
Ravaioli, Alessandra
Dal Maso, Luigino
Falcini, Fabio
Mangone, Lucia
Massarut, Samuele
Schirosi, Laura
Crispo, Anna
Vici, Patrizia
Franceschi, Silvia
De-Implementation of Axillary Staging and Radiotherapy in Low-Risk Breast Cancer Patients Aged 70–79 Years from Six Italian Cancer Institutes
title De-Implementation of Axillary Staging and Radiotherapy in Low-Risk Breast Cancer Patients Aged 70–79 Years from Six Italian Cancer Institutes
title_full De-Implementation of Axillary Staging and Radiotherapy in Low-Risk Breast Cancer Patients Aged 70–79 Years from Six Italian Cancer Institutes
title_fullStr De-Implementation of Axillary Staging and Radiotherapy in Low-Risk Breast Cancer Patients Aged 70–79 Years from Six Italian Cancer Institutes
title_full_unstemmed De-Implementation of Axillary Staging and Radiotherapy in Low-Risk Breast Cancer Patients Aged 70–79 Years from Six Italian Cancer Institutes
title_short De-Implementation of Axillary Staging and Radiotherapy in Low-Risk Breast Cancer Patients Aged 70–79 Years from Six Italian Cancer Institutes
title_sort de-implementation of axillary staging and radiotherapy in low-risk breast cancer patients aged 70–79 years from six italian cancer institutes
topic Communication
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10137373/
https://www.ncbi.nlm.nih.gov/pubmed/37185431
http://dx.doi.org/10.3390/curroncol30040318
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