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Patients electing to have PET rather than surgery for operable breast cancer are a high risk of treatment failure

Thomas, R; Rowell, R; Crichton, S; Cain, H; (2018) Patients electing to have PET rather than surgery for operable breast cancer are a high risk of treatment failure. Breast Cancer Research and Treatment , 172 (3) pp. 597-601. 10.1007/s10549-018-4943-3. Green open access

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Abstract

Background: Primary endocrine therapy (PET) is a treatment option for elderly patients with ER-positive breast cancer enabling frail patients to avoid surgery. As a long-term treatment option, it has been shown to be inferior to surgery in controlling local disease. Decision-making in these patients is crucial in avoiding treatment failure. We examined the influence of decision-making on outcomes of PET failure as a secondary analysis as part of a large observational study. Methods: Consecutive patients treated with PET between 2005 and 2015 for operable breast cancers were included in a retrospective observational study in 3 breast centres in the North-East. Treatment decision processes were examined by case note review and outcomes of treatment success or failure recorded. Results: 488 patients were included with mean follow-up of 31 months. Overall 63 (12%) experienced treatment failure. 227 (46.6%) were given a choice between surgery and PET at diagnosis. Logistic regression identified older age [OR 0.94 (0.91–0.96) p < 0.001] and reduced mobility [OR 0.6 (0.37–0.97) p 0.036] to be less likely offered surgery. Those offered surgery were more likely to experience treatment failure with PET [SHR 1.78 (1.05–3.02) p 0.033]. Conclusions: Despite a low failure rate in our series (literature failure rates vary between 12 and 85%), these results suggest that those actively offered a choice between surgery and PET are at greater risk of failure when choosing PET.

Type: Article
Title: Patients electing to have PET rather than surgery for operable breast cancer are a high risk of treatment failure
Open access status: An open access version is available from UCL Discovery
DOI: 10.1007/s10549-018-4943-3
Publisher version: http://doi.org/10.1007/s10549-018-4943-3
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Primary endocrine therapy; breast cancer; elderly
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology > MRC Clinical Trials Unit at UCL
URI: https://discovery.ucl.ac.uk/id/eprint/10067974
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