Radiotherapy in Patients 70 Years and Older With Triple-Negative Breast Cancer

Despite the more favorable tumor outcome attributed to older patients, review of the data from the National Cancer Data Base for triple-negative breast cancer patients demonstrates a continued benefit with the addition of radiotherapy (RT) in older patients with clinicopathologic indications for RT use. Purpose To evaluate the use of radiotherapy (RT) in older patients with triple-negative breast cancer (TNBC). Patients and Methods The National Cancer Data Base (NCDB) is a comprehensive national database that captures approximately 70% of newly diagnosed cancer patients in the United States. Data for patients meeting the criteria of nonmetastatic TNBC were extracted and analyzed. Results A total of 44,731 TNBC patients with indications for postoperative RT were identified. Median patient age was 59 (range, 19-90) years. Maximum RT use occurred between the ages of 46 and 70, with rapid decline in patients older than 70 years. Overall, there was a statistically significant improvement in overall survival (OS) with the addition of RT. Of the 24 variables evaluated, 23 were statistically significant on univariate analysis. On multivariate analysis a majority of these factors including facility location, age, Charlson/Deyo comorbidity condition score, and tumor characteristics (lymph node status, pathologic T stages, and use of systemic chemotherapy) remained significant. The use of RT was associated with improved OS rates in both the older (5-year OS, 66.4% vs. 42.6%, P < .001) and younger (5-year OS, 77.3% vs. 63.2%, P < .001) patient groups. Conclusion In this group of high-risk patients, there was decreased use of RT in older patients. In our study of a large patient population with TNBC, RT was associated with increased OS rates in both younger and older patients, and RT should be strongly considered, when indicated by clinicopathologic factors, in patients with TNBC.