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Following breast cancer elderly patients treatment at a publicuniversity hospital clinical oncology department
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2013 SIOG Poster Abstracts
Results: 1723 patients over 70 years, treated between 1999 and 2004, were included. The median follow-up was 5.6 years. Among these patients, 378 (22%) had tumors less than 1 cm. The clinical and biological characteristics (HR, HER2, SBR grade) of small tumors were similar in the different groups and were comparable to BC occurring before 70 years. 334 (88%) operated patients received radiotherapy, 309 (83%) patients received hormonal therapy and only 10 (2.7%) received chemotherapy. Despite the tumor size, the rate of conservative surgery decreased with age, while the percentage of mastectomy increased significantly to 22% after 80 years (22% between 80 and 84 years and 25% after 85 years). In univariate analysis, age at diagnosis (P b0.0001), hormone receptor negativity (P = 0.0009) and HER2 overexpression (P = 0.0086) were significantly associated with poor survival. After multivariate analysis, overexpression of HER2 was the only significant prognostic factor with a risk of death from breast cancer increased by 4.77 times compared to HER2 negative patients (95% CI 1.366, 16.710). Conclusion: If the clinical and biological characteristics of infracentimetric breast cancer are conserved regardless of age, the management of these tumors were very different in this large cohort study. HER2 overexpression appears to be a main prognosis factor for small BC occurring after 70 years. Studies are needed to clarify the characteristics and prognosis of these tumors in order to personalize treatment according to age and comorbidities.
24.8% (85) was treated with adjuvant chemotherapy in early stages following these regimens: AC 58.8% (50), CMF 21.1% (18), AC.T 15.3%, TAC 3.5%. Only 2 patients ≥85 age received adjuvant chemotherapy. 14.89% (14/94) of the carcinoma in situ cases developed local relapse. 2.27% (1/44) of the stage I cases, 21.7% (35/161) of the stages II cases relapsed. 65.7% of the stage II cases developed localregional relapse. Conclusion: Breast cancer incidence in elderly patients is growing up. In ≥85 age patients therapies were modified because age and baseline comorbidities. 77.6% of the adjunvant chemotherapy was antraciclinas. The majority of ≥85 age patients with local-regional disease didn’t receive adjuvant chemotherapy. Adjuvant endocrine therapy was a mainstay of treatment for hormone receptor-positive patients. Disclosure of Interest: None Declared Keywords: Breast cancer References 1. ME, Schreurs WH, Uppeschoten JM, Smorenburg CH. BreastCancer in the Elderly: Retrospective Study on Diagnosis and TreatmentAccording to National Guidelines. Breast J 2009;15:26–33. 2. Foster JA, Salina GD, Mansell D, Williamson JC, Casebeer LL, et al. How Does Older Age Influence Oncologists’ Cancer Management? Oncologist 2010;15:584–592. 3. R, Wesley MN, Ries LA, et al. Effect of age and comorbidity inpostmenopausal breast cancer patients aged 55 years and older. JAMA 2001;285:885–892.
Disclosure of Interest: None Declared doi:10.1016/j.jgo.2013.09.017 Keywords: Breast cancer, Epidemiology doi:10.1016/j.jgo.2013.09.016
Track 1 - Solid Tumours in the Elderly Breast cancer in eldery patients P013 Following breast cancer elderly patients treatment at a public university hospital clinical oncology department J. Lara*, E. Batagelj, R. Sanchez, M. Caicedo, H. Cordoba, D.V. Bejarano, M. Paskevicius, H. Brausteni, I. Cudris, J. Tomala, L. Friedirich, A. Romero, A. Acebo, M. Locatti, M. Avila, G. Streich. Hospital Militar Central, Buenos Aires, Argentina Introduction: Breast cancer in older patients is an increasingly common problem facing the oncologist. The age of the elderly patient shouldn’t have influence on their treatments. The optimal treatment for elderly cancer patients should consider life expectancies, treatments’ benefits and tolerability and patients’ preferences Objectives: Our objective was to make an retrospective analysis considering patients’ histological and clinical characteristics, baseline comorbidities, treatments characteristics, and patients’ responses and progress. Methods: Breast cancer female ≥65 age were enrolled from January 2005 to January 2012 at the Military Hospital Clinical Oncology Department. All of them belong to the media economical social class. Results: 343 pts were enrolled. At the study entry, 41% (143) were age between 65-75 years, 42.5% (146) 76-85 years and 15.7 (54) ≥86 age, median age 76 (range 65-97). 16% hadn’t baseline comorbidities. 28% were diagnosed for carcinoma in situ, 60% for stage I and II, 10% for stage III and 2% for stage IV. 67% of the cases who didn’t perform surgery ≥75 age. 9% of the cases received neoadyuancy and didn’t reach statically significance in age. 71.8% were hormone receptor-positive, 77.7%, of this cases was treated with tamoxifeno, 22.3% aromatase inhibitors. During the last 5 years, the tendency was to include aromatase inhibitors in the adjuvant endocrine therapy.
Track 1 - Solid Tumours in the Elderly Breast cancer in eldery patients P014 Management of new diagnosis breast carcinoma: An age comparison of those aged over and under seventy years U. Walsh*, A. Clarke, M. Mullan, S. Thrush, R. Bright-Thomas. Breast Surgery, Worcestershire Royal Hospital, Worcester, UK Introduction: Within the National Health Service there is a legal, moral and professional duty against age discrimination. A recent RCS of England report, “Access All Ages” and NICE (CG 80) reinforces this “Women should be offered the same breast cancer treatment regardless of age”. Objectives: To determine if the management of breast carcinoma patients differs by age in our trust. Methods: Retrospective observational study. The UK cancer registry was used to identify patients with breast carcinoma between 2010 and 2013. Computerised random number generation was used to select 100 patients from each age category (b70, N70). The following data was extracted from patient records and compared across groups; tumour size, tumour grade, ASA grade, management, breast surgery type, axillary involvement and axillary surgery. Student T-tests and Chi Square were used to test for difference as data included both continuous and nominal variables. Results: Mean age = 55 yrs (34-70) and 79 yrs (70-94) for the b70 and N70 groups respectively. Tumour grade, size of tumour, proportion who had axillary involvement and appropriate axillary surgery (DCIS cases excluded) did not differ significantly between groups P values at 95% CI = 0.155, 0.065, 0.177 and 0.288 respectively. Significant differences were found in the proportion managed surgically; N = 100 (b70) and N = 76(N70) P = 0.000 and in ASA grades, mean = 1(b70) and 2(N70) P = 0.000. Within group analysis of surgical versus endocrine only management in the N70’s showed a significant difference in age P = 0.000 and ASA grades P = 0.000. The mean age and ASA grade for the surgery group was 78 yrs and ASA 2. The endocrine only group were older (mean age 85 yrs) and had a higher mean ASA grade (3). In terms
2013 SIOG Poster Abstracts
Results: 1723 patients over 70 years, treated between 1999 and 2004, were included. The median follow-up was 5.6 years. Among these patients, 378 (22%) had tumors less than 1 cm. The clinical and biological characteristics (HR, HER2, SBR grade) of small tumors were similar in the different groups and were comparable to BC occurring before 70 years. 334 (88%) operated patients received radiotherapy, 309 (83%) patients received hormonal therapy and only 10 (2.7%) received chemotherapy. Despite the tumor size, the rate of conservative surgery decreased with age, while the percentage of mastectomy increased significantly to 22% after 80 years (22% between 80 and 84 years and 25% after 85 years). In univariate analysis, age at diagnosis (P b0.0001), hormone receptor negativity (P = 0.0009) and HER2 overexpression (P = 0.0086) were significantly associated with poor survival. After multivariate analysis, overexpression of HER2 was the only significant prognostic factor with a risk of death from breast cancer increased by 4.77 times compared to HER2 negative patients (95% CI 1.366, 16.710). Conclusion: If the clinical and biological characteristics of infracentimetric breast cancer are conserved regardless of age, the management of these tumors were very different in this large cohort study. HER2 overexpression appears to be a main prognosis factor for small BC occurring after 70 years. Studies are needed to clarify the characteristics and prognosis of these tumors in order to personalize treatment according to age and comorbidities.
24.8% (85) was treated with adjuvant chemotherapy in early stages following these regimens: AC 58.8% (50), CMF 21.1% (18), AC.T 15.3%, TAC 3.5%. Only 2 patients ≥85 age received adjuvant chemotherapy. 14.89% (14/94) of the carcinoma in situ cases developed local relapse. 2.27% (1/44) of the stage I cases, 21.7% (35/161) of the stages II cases relapsed. 65.7% of the stage II cases developed localregional relapse. Conclusion: Breast cancer incidence in elderly patients is growing up. In ≥85 age patients therapies were modified because age and baseline comorbidities. 77.6% of the adjunvant chemotherapy was antraciclinas. The majority of ≥85 age patients with local-regional disease didn’t receive adjuvant chemotherapy. Adjuvant endocrine therapy was a mainstay of treatment for hormone receptor-positive patients. Disclosure of Interest: None Declared Keywords: Breast cancer References 1. ME, Schreurs WH, Uppeschoten JM, Smorenburg CH. BreastCancer in the Elderly: Retrospective Study on Diagnosis and TreatmentAccording to National Guidelines. Breast J 2009;15:26–33. 2. Foster JA, Salina GD, Mansell D, Williamson JC, Casebeer LL, et al. How Does Older Age Influence Oncologists’ Cancer Management? Oncologist 2010;15:584–592. 3. R, Wesley MN, Ries LA, et al. Effect of age and comorbidity inpostmenopausal breast cancer patients aged 55 years and older. JAMA 2001;285:885–892.
Disclosure of Interest: None Declared doi:10.1016/j.jgo.2013.09.017 Keywords: Breast cancer, Epidemiology doi:10.1016/j.jgo.2013.09.016
Track 1 - Solid Tumours in the Elderly Breast cancer in eldery patients P013 Following breast cancer elderly patients treatment at a public university hospital clinical oncology department J. Lara*, E. Batagelj, R. Sanchez, M. Caicedo, H. Cordoba, D.V. Bejarano, M. Paskevicius, H. Brausteni, I. Cudris, J. Tomala, L. Friedirich, A. Romero, A. Acebo, M. Locatti, M. Avila, G. Streich. Hospital Militar Central, Buenos Aires, Argentina Introduction: Breast cancer in older patients is an increasingly common problem facing the oncologist. The age of the elderly patient shouldn’t have influence on their treatments. The optimal treatment for elderly cancer patients should consider life expectancies, treatments’ benefits and tolerability and patients’ preferences Objectives: Our objective was to make an retrospective analysis considering patients’ histological and clinical characteristics, baseline comorbidities, treatments characteristics, and patients’ responses and progress. Methods: Breast cancer female ≥65 age were enrolled from January 2005 to January 2012 at the Military Hospital Clinical Oncology Department. All of them belong to the media economical social class. Results: 343 pts were enrolled. At the study entry, 41% (143) were age between 65-75 years, 42.5% (146) 76-85 years and 15.7 (54) ≥86 age, median age 76 (range 65-97). 16% hadn’t baseline comorbidities. 28% were diagnosed for carcinoma in situ, 60% for stage I and II, 10% for stage III and 2% for stage IV. 67% of the cases who didn’t perform surgery ≥75 age. 9% of the cases received neoadyuancy and didn’t reach statically significance in age. 71.8% were hormone receptor-positive, 77.7%, of this cases was treated with tamoxifeno, 22.3% aromatase inhibitors. During the last 5 years, the tendency was to include aromatase inhibitors in the adjuvant endocrine therapy.
Track 1 - Solid Tumours in the Elderly Breast cancer in eldery patients P014 Management of new diagnosis breast carcinoma: An age comparison of those aged over and under seventy years U. Walsh*, A. Clarke, M. Mullan, S. Thrush, R. Bright-Thomas. Breast Surgery, Worcestershire Royal Hospital, Worcester, UK Introduction: Within the National Health Service there is a legal, moral and professional duty against age discrimination. A recent RCS of England report, “Access All Ages” and NICE (CG 80) reinforces this “Women should be offered the same breast cancer treatment regardless of age”. Objectives: To determine if the management of breast carcinoma patients differs by age in our trust. Methods: Retrospective observational study. The UK cancer registry was used to identify patients with breast carcinoma between 2010 and 2013. Computerised random number generation was used to select 100 patients from each age category (b70, N70). The following data was extracted from patient records and compared across groups; tumour size, tumour grade, ASA grade, management, breast surgery type, axillary involvement and axillary surgery. Student T-tests and Chi Square were used to test for difference as data included both continuous and nominal variables. Results: Mean age = 55 yrs (34-70) and 79 yrs (70-94) for the b70 and N70 groups respectively. Tumour grade, size of tumour, proportion who had axillary involvement and appropriate axillary surgery (DCIS cases excluded) did not differ significantly between groups P values at 95% CI = 0.155, 0.065, 0.177 and 0.288 respectively. Significant differences were found in the proportion managed surgically; N = 100 (b70) and N = 76(N70) P = 0.000 and in ASA grades, mean = 1(b70) and 2(N70) P = 0.000. Within group analysis of surgical versus endocrine only management in the N70’s showed a significant difference in age P = 0.000 and ASA grades P = 0.000. The mean age and ASA grade for the surgery group was 78 yrs and ASA 2. The endocrine only group were older (mean age 85 yrs) and had a higher mean ASA grade (3). In terms