91 Adverse Effects and Financial Burden of Radiation Therapy in Patients With T3N0M0 Luminal Breast Cancer

Publication
Article
Miami Breast Cancer Conference® Abstracts Supplement42nd Annual Miami Breast Cancer Conference® - Abstracts
Volume 39
Issue 4
Pages: 68

91 Adverse Effects and Financial Burden of Radiation Therapy in Patients With T3N0M0 Luminal Breast Cancer

91 Adverse Effects and Financial Burden of Radiation Therapy in Patients With T3N0M0 Luminal Breast Cancer

Background/Significance

There is no definite recommendation regarding post-mastectomy radiation therapy (PMRT) in patients with T3N0M0, luminal breast cancer. We have previously shown that in patients with hormone receptor (HR)–positive, HER2-negative tumors and low recurrence prediction scores experience a comparable rate of recurrence irrespective of PMRT. Radiation therapy adds morbidity including dermatitis/fibrosis, breast/chest wall pain, impaired mobility, breast/arm edema, and cardiac adverse effects (AEs). Our goal is to investigate the AEs of radiation therapy and to use Medicare reimbursement data to assess the financial burden of radiation therapy in this patient population.

Materials and Methods

We performed a retrospective chart review of all female patients at our institution with T3N0M0, HR–positive, HER2-negative breast cancer who underwent mastectomy between 2012 and 2022. Patients were divided into 2 groups based on the administration of PMRT, and early and late AEs of PMRT were recorded. We then analyzed the cost of radiation therapy based on Medicare reimbursement data. The additional cost of treating radiation therapy-related AEs was not included.

Results

Of the 84 patients who met the study criteria, 56% (n = 47) underwent PMRT, and 44% (n = 37) did not. The mean age was 60.9 years (± 13.0), and the median follow-up was 82 months (range, 4-152). There was no statistical difference in age, mean estrogen receptor (ER) or progesterone receptors (PR) H-score, or T stage between the PMRT and no-radiation therapy groups. In the PMRT group, 27% (n = 10) of patients had immediate breast reconstruction.

There was no significant difference in local recurrence rates (2.1% and 5.4% in the PMRT and no-PMRT groups, respectively; P = .42), or distant recurrence rates (8.5% and 4.3% in the PMRT and no-PMRT groups, respectively; P = .58). Radiation therapy-related local complication was seen in 26 patients; minor skin toxicity (hyperpigmentation, telangiectasia, skin thickening, n = 20), major skin toxicity (n = 2), dehiscence/necrosis (n = 1), Lichen sclerosus (n = 1), angiosarcoma (n = 1), implant capsular contraction (n = 1), and cardiac events were seen in 29 patients (events related with coronary artery disease, stroke, arrhythmia). In this cohort, radiation therapy would cost Medicare an additional $656,619 ($13,970 per patient).

Conclusion

In the T3N0M0, HR–positive, HER2-negative breast cancer group, radiation therapy did not reduce the recurrence rate of breast cancer, but it significantly increased morbidity and costs. Consistent with the SUPREMO trial result, omitting radiation could reduce patient AEs and financial stress in this patient population.

Articles in this issue

40 Frequency of Documented IHC Score in Patients With HER2-Negative Breast Cancer in the US: An Observational Study Using Guardian Research Network Data
40 Frequency of Documented IHC Score in Patients With HER2-Negative Breast Cancer in the US: An Observational Study Using Guardian Research Network Data
41 Provider Preferences and Practices in Testing and Reporting HER2 Immunohistochemistry in Patients With Breast Cancer: A Survey and Interview Study Among US Pathologists and Oncologists
41 Provider Preferences and Practices in Testing and Reporting HER2 Immunohistochemistry in Patients With Breast Cancer: A Survey and Interview Study Among US Pathologists and Oncologists
42 Exploring the Treatment Gap in High-Risk HR+, HER2– Early Breast Cancer: Eligible Patients Not Receiving Abemaciclib in the US
42 Exploring the Treatment Gap in High-Risk HR+, HER2– Early Breast Cancer: Eligible Patients Not Receiving Abemaciclib in the US
TPS 43 ADELA: A Double-Blind, Placebo-Controlled, Randomized Phase 3 Trial of Elacestrant + Everolimus vs Elacestrant + Placebo in ER+/HER2– Advanced Breast Cancer Patients With ESR1-Mutated Tumors Progressing on Endocrine Therapy
TPS 43 ADELA: A Double-Blind, Placebo-Controlled, Randomized Phase 3 Trial of Elacestrant + Everolimus vs Elacestrant + Placebo in ER+/HER2– Advanced Breast Cancer Patients With ESR1-Mutated Tumors Progressing on Endocrine Therapy
45 A Phase 3 Randomized Study of Adjuvant Sacituzumab Tirumotecan Plus Pembrolizumab vs Treatment of Physician’s Choice in Patients With Triple-Negative Breast Cancer Who Received Neoadjuvant Therapy and Did Not Achieve a Pathological Complete Response at Surgery
45 A Phase 3 Randomized Study of Adjuvant Sacituzumab Tirumotecan Plus Pembrolizumab vs Treatment of Physician’s Choice in Patients With Triple-Negative Breast Cancer Who Received Neoadjuvant Therapy and Did Not Achieve a Pathological Complete Response at Surgery
46 Neoadjuvant Pembrolizumab or Placebo Plus Chemotherapy Followed by Adjuvant Pembrolizumab or Placebo for High-Risk, Early-Stage Triple-Negative Breast Cancer: Overall Survival and Subgroup Results From the Phase 3 KEYNOTE-522 Study
46 Neoadjuvant Pembrolizumab or Placebo Plus Chemotherapy Followed by Adjuvant Pembrolizumab or Placebo for High-Risk, Early-Stage Triple-Negative Breast Cancer: Overall Survival and Subgroup Results From the Phase 3 KEYNOTE-522 Study
48 Prevalence of “HER2 Ultra-Low” Among Advanced Breast Cancer Patients With Historical IHC0 Status
48 Prevalence of “HER2 Ultra-Low” Among Advanced Breast Cancer Patients With Historical IHC0 Status
49 Clinical Characteristics and Treatment Persistence in US Patients With HR+/HER2–, Node-Positive Early Breast Cancer Treated With Abemaciclib: Real-World Study From First Year After Approval
49 Clinical Characteristics and Treatment Persistence in US Patients With HR+/HER2–, Node-Positive Early Breast Cancer Treated With Abemaciclib: Real-World Study From First Year After Approval
52 Correlation and Prediction of Complete Pathologic Response Rates and Ki-67 in Patients Receiving Neoadjuvant Immunotherapy for Triple-Negative Breast Cancer
52 Correlation and Prediction of Complete Pathologic Response Rates and Ki-67 in Patients Receiving Neoadjuvant Immunotherapy for Triple-Negative Breast Cancer
53 Comparison of Surgical Complications With Direct-to-Implant vs Tissue Expander Reconstruction After Wise Pattern Skin-Sparing Mastectomy
53 Comparison of Surgical Complications With Direct-to-Implant vs Tissue Expander Reconstruction After Wise Pattern Skin-Sparing Mastectomy
54 The Treatment of Breast Cancer With Percutaneous Thermal Ablation: Results of the THERMAC Trial
54 The Treatment of Breast Cancer With Percutaneous Thermal Ablation: Results of the THERMAC Trial
55 Do Genetic Counseling and Testing Affect Rates of Contralateral Prophylactic Mastectomy in Patients Without Clinically Actionable Mutations?
55 Do Genetic Counseling and Testing Affect Rates of Contralateral Prophylactic Mastectomy in Patients Without Clinically Actionable Mutations?
56 Paternal vs Maternal Inheritance of a BRCA Mutation: Is There a Difference in Presentation and Stage of Breast Cancer at Diagnosis?
56 Paternal vs Maternal Inheritance of a BRCA Mutation: Is There a Difference in Presentation and Stage of Breast Cancer at Diagnosis?
57 Tumor Morphology Concordance in Multifocal/Multicentric Triple- Negative and HER2+ Breast Cancers
57 Tumor Morphology Concordance in Multifocal/Multicentric Triple- Negative and HER2+ Breast Cancers
59 Are Choosing Wisely Guidelines Applicable to Patients With a High Ki-67 Proliferation Index and Magee Equation Score?
59 Are Choosing Wisely Guidelines Applicable to Patients With a High Ki-67 Proliferation Index and Magee Equation Score?
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