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Radiotherapy Still Used in Some Older Breast Cancer Patients, In Spite of Little Benefit

By MedImaging International staff writers
Posted on 20 Mar 2012

Although a large clinical study demonstrated that radiotherpay has limited benefit in treating breast cancer in some older women, there was little change in the use of radiation among older women in the US Medicare program.

The Yale School of Medicine (New Haven, CT, USA ) researchers reported their findings in the March 2012 Journal of Clinical Oncology. “We were surprised by these results,” said lead author Cary P. Gross, MD, associate professor of internal medicine at Yale School of Medicine. “Clinical trials are considered the gold standard of medical research and in this case the trial was influential enough to lead to a change in treatment guidelines. We expected it to have more of an impact on clinical care at the bedside.”

The typical treatment course for older women with early stage breast cancer is breast-conserving surgery followed by radiation therapy. The purpose of added radiation therapy is to reduce recurrence of the disease. However, many older women have less aggressive tumors that put them at low risk for tumor recurrence.

The Yale investigators assessed the impact of a large research trial funded by the US National Cancer Institute (NCI; Bethesda, MD, USA) on clinical practice. Published in 2004, that NCI trial revealed that radiation therapy had only a small benefit for some women 70 and older with early stage, low-risk breast cancer. As a result of this study, breast cancer-treatment guidelines were changed to indicate that radiation therapy could be considered optional for such patients.

However, in the years following implementation of the new guidelines, Dr. Gross and his colleagues discovered that there has been minimal impact on the clinical care of older women with breast cancer. The team evaluated the use of radiation therapy among Medicare beneficiaries diagnosed with early stage breast cancer before and after the large NCI clinical trial was published. Approximately 79% of women received radiation before to the study compared with 75% after.

Even among the oldest women (85-94 years), the trial appeared to have little effect on clinician practice: The use of radiation decreased from 37% prior to the study to 33% after. “These findings have important implications for how the results of clinical research studies are translated into practice,” said Dr. Gross, who emphasized that the US government invested over USD 1 billion in comparative effectiveness research as part of the American Recovery and Reinvestment Act of 2009. “Our societal interest in funding this type of research is appropriate, and the need is great, but we must ensure that the results of such research extend beyond the journal page and are actually incorporated into clinical decision-making.”

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67 (41.007995605469): select jos_linkedin.link from jos_linkedin where cat=10

68 (50.067901611328): SELECT fid FROM jos_deeppockets WHERE id=294739867 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294739867 AND published='1' LIMIT 1

69 (40.054321289062): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=211 ORDER BY `ordering`

70 (452.04162597656): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294739867 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (338.07754516602): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294739867 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (53.167343139648): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (59.843063354492): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (77.009201049805): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (51.975250244141): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294739867 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (30.040740966797): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294739867 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (44.107437133789): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (29.802322387695): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (43.869018554688): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (109.91096496582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739867 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739867 AND published='1' LIMIT 1

105 (42.915344238281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739867 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739867 AND published='1' LIMIT 1

106 (84.877014160156): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294739867 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (49.114227294922): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294739867 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (72.002410888672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739867 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739867 AND published='1' LIMIT 1

109 (44.822692871094): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739867 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739867 AND published='1' LIMIT 1

110 (46.968460083008): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294739867 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (464.20097351074): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294739867 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (559.09156799316): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (384.09233093262): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (113.01040649414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739867 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739867 AND published='1' LIMIT 1

115 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739867 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739867 AND published='1' LIMIT 1

116 (217.19932556152): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739867 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739867 AND published='1' LIMIT 1

117 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739867 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739867 AND published='1' LIMIT 1

118 (123.02398681641): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739867 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739867 AND published='1' LIMIT 1

119 (92.983245849609): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739867 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739867 AND published='1' LIMIT 1

120 (73.19450378418): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739867 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739867 AND published='1' LIMIT 1

121 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739867 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739867 AND published='1' LIMIT 1

122 (267.02880859375): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 24136.066436768): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

124 (513.07678222656): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294739867 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294739867 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 7967.9489135742): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (153.0647277832): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (68.187713623047): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

128 (37.908554077148): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

129 (51.021575927734): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

130 (29.802322387695): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

131 (372.88665771484): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

132 (41.007995605469): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

133 (30.994415283203): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

134 (28.848648071289): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

135 (!!!!! 4003.0479431152): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739867 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (540.01808166504): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739867 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (45.061111450195): SELECT name FROM jos_deeppockets WHERE id=211

138 (30.040740966797): SELECT name FROM jos_deeppockets WHERE id=211

139 (623.94142150879): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (463.00888061523): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (76.055526733398): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739867 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739867 AND published='1' LIMIT 1

142 (42.915344238281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739867 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739867 AND published='1' LIMIT 1

143 (!!!!! 14957.904815674): TRUNCATE TABLE jos_trademed_module

144 (227.92816162109): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294739867 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (!!!!! 2142.9061889648): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294739867 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (386.95335388184): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739867 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (145.91217041016): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739867 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (78.916549682617): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739867 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739867 AND published='1' LIMIT 1

149 (56.982040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739867 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739867 AND published='1' LIMIT 1

150 (!!!!! 1449.1081237793): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

151 (85.830688476562): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739867 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739867 AND published='1' LIMIT 1

152 (58.174133300781): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739867 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739867 AND published='1' LIMIT 1

153 (56.028366088867): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294739867 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294739867 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (41.007995605469): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

155 (34.093856811523): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

156 (51.975250244141): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (88.214874267578): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739867 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739867 AND published='1' LIMIT 1

158 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739867 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739867 AND published='1' LIMIT 1

159 (588.17863464355): select jos_twitters.link from jos_twitters where cat=10

160 (51.975250244141): select jos_facebook.link from jos_facebook where cat=10

161 (36.001205444336): select jos_google_plus.link from jos_google_plus where cat=10

162 (32.901763916016): select jos_linkedin.link from jos_linkedin where cat=10

163 (250.81634521484): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

164 (!!!!! 1286.0298156738): insert into jos_banners_delta values (14615,'2025-06-21 03:48:29','216.73.216.120','view'),(14202,'2025-06-21 03:48:29','216.73.216.120','view'),(14203,'2025-06-21 03:48:29','216.73.216.120','view')

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