Role of Radiotherapy in Elderly Patients (≥65 Years) With Triple-Negative Breast Cancer: A Systematic Review and Meta-Analysis

This is the first meta-analysis evaluating the benefit of adjuvant radiotherapy in older patients (≥65 years) with triple-negative breast cancer (TNBC). The medical literature was searched for all randomized controlled trials, nonrandomized controlled trials, and cohort studies with more than one treatment arm that evaluated radiation therapy for TNBC in patients aged >65 years. The primary outcome was overall survival. Four cohort studies (2015–2019) were eligible for analysis, including a total of 10,710 patients with TNBC of whom 7,209 underwent radiotherapy. Two were large retrospective population-based studies that yielded major findings on adjusted multivariable analysis. Patients who underwent radiotherapy (n = 6283/8526) had a significantly better 5-year overall survival than patients who did not (77% vs. 55%, p<0.001). The addition of radiotherapy (n = 815/1957) was associated with better cancer-specific survival. Of the two smaller studies, one prospective study reported similar survivability for treatment with breast-conserving surgery, chemotherapy, and radiotherapy or mastectomy with radiation, or mastectomy alone, and the other retrospective study found that adding radiotherapy had no effect on 5-year overall survival. Multivariate analyses of data from the two large retrospective population-based studies suggested that adding radiotherapy to breast-conserving surgery may improve overall and disease-free survival in elderly patients with TNBC.