• Quyen D Chu, Kaelen L Medeiros, Meijiao Zhou, Prakash Peddi, and Xiao-Cheng Wu.
• Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA; Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center in Shreveport, Shreveport, LA. Electronic address: qchu@lsuhsc.edu.
• J. Am. Coll. Surg. 2016 Apr 1; 222 (4): 667-78.

BackgroundThe Cancer and Leukemia Group B (CALGB) 9343 trial demonstrated that adjuvant radiation therapy (RT) can be omitted in women aged 70 years or older, with small, estrogen receptor (ER)+ breast cancer. We postulated that RT usage after CALGB's publication should have decreased over time.Study DesignWe evaluated a cohort of 205,860 women aged 70 years or older, with stage I, ER+/progesterone receptor (PR)+ breast cancer with lumpectomy, diagnosed between 1998 and 2012, in the National Cancer Data Base. Clinicopathologic and sociodemographic variables were compared between pre-CALGB and post-CALGB publication (circa 2004). Univariate and multivariate analysis were used.ResultsRadiation therapy usage decreased by only 2.95% after CALGB publication (68.71% vs 65.76%; p < 0.0001). Almost one-third of women with short life expectancy (≥85 years) received RT in the post-CALGB group. Significant predictors (p < 0.01) of lowest RT use include advanced age, increased great circle distance, academic research program, East South Central region, rural population < 2,500 not adjacent to a metropolitan area, low income level, high comorbidity index, small tumor, well-differentiated histology, residual tumor, and lack of receipt of anti-hormonal therapy.ConclusionsThe CALGB trial had a minimal impact on the rate of adjuvant RT use among elderly women with small, hormone positive breast cancers. Significant variation in RT usage exists across sociodemographic strata.Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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