Would you offer whole breast RT in an elderly patient with early stage breast cancer with EIC?

If the patient meets CALGB criteria and has negative margins, then EIC is not a contraindication to the omission of radiation.

More generally, when deciding whom to treat among the universe of patients who meet CALGB criteria, factors that influence me are patient preferences and values (to what extent are they willing to accept a small risk for the small reduction of local recurrence), age and comorbidities (are they 70 with no comorbidities or 85 with many comorbidities), and the biology of the cancer (grade, LVI, ER/PR/HER2/ki67, oncotype if available). There is no single formula and no identical patient and shared decision making is crucial.

EIC in-and-of-itself would not drive me to offer RT given that CALGB 9343 likely included patients with this finding, among other high risk features. I would, however, consider the constellation of risk factors in trying to place this patient on the spectrum of CALGB9343 risk. For example, a patient with high grade disease, extensive LVI and EIC would be more concerning than EIC alone on a background of otherwise low-risk biology.

That said, the overall burden of competing risks plays the largest role in deciding whether to offer adjuvant radiotherapy to an older patient. It is important to remember that the CALGB trial had a 10-year overall survival approximating 2/3rds in both the TamRT and Tam alone arms, suggesting significant comorbid...

I agree with the comments of my colleagues above, especially regarding shared decision making in discussion with the patient. Not all elderly patients have indolent disease, so a thorough review of tumor markers and clinicopathologic risk features should be part of the decision process. EIC alone with negative margins would not warrant whole breast radiation. The patient's performance status and co-morbidities are key. A healthy 70-75 year old in the US with minimal comorbid conditions will have a life expectancy of 10-15 years. Breast radiation is also very well tolerated with minimal serious toxicities, while compliance with AI endocrine therapy in this age group is not high.

I find in my practice that a lot of elderly women are not comf...