老年女性早期雌激素受体阳性（ER+）浸润性乳腺癌（IBC）患者存在过度治疗的风险。指南允许对70岁或以上T1、临床淋巴结阴性（cN0）和ER+ IBC的女性进行乳腺保留手术（BCS）后的前哨淋巴结活检（SLNB）和放射治疗放疗省略。本研究旨在评估COVID-19大流行后低危IBC老年女性的放疗和SLNB节约效果。通过分析一家机构的数据库，确定2012年至2022年年龄为70岁或以上的女性进行了IBC的BCS治疗。患者被分为两个组：（1）符合放疗和SLNB省略条件的低危IBC患者（pT1、cN0和ER+/HER2-），以及（2）不符合节约条件的高危IBC患者（pT2-T4、cN+、ER-或HER2+）。分析了两组患者的临床病理变量。共招募了881名患者。对于低危IBC患者，从2012年到2019年，放疗率保持稳定。然而，从2020年到2022年，放疗利用率显著下降（2012年58%对比2022年36%，p = 0.04）。相反，高危IBC患者的放疗使用率从2012年到2022年保持稳定（2012年79%，2022年79%，p = 0.95）。在低危IBC患者中，SLNB率从2012年的86%下降到2022年的56%，但这一趋势早于2020年。年轻年龄、肿瘤较大、3级病情和淋巴结受累是与低危IBC患者的SLNB和放疗接受情况显著相关的因素（p < 0.01）。该研究证明了COVID-19大流行后低危IBC老年女性的放疗适度减少并得到了持续的控制。© 2023. 作者。

Older women with early-stage estrogen receptor-positive (ER+) invasive breast cancer (IBC) are at risk for overtreatment. Guidelines allow for sentinel lymph node biopsy (SLNB) and radiotherapy omission after breast-conserving surgery (BCS) for women 70 years of age or older with T1, clinical node negativity (cN0), and ER+ IBC. The study objective was to evaluate radiotherapy and SLNB de-implementation in older women with low-risk IBC after the resource limitations of the COVID-19 pandemic.An institutional database was analyzed to identify women 70 years of age or older who received BCS for IBC from 2012 to 2022. The patients were divided into two cohorts: (1) patients with low-risk IBC (pT1, cN0, and ER+/HER2-) who were eligible for radiotherapy and SLNB omission and (2) patients with high-risk IBC (pT2-T4, cN+, ER-, or HER2+) who were ineligible for therapy omission. Clinicopathologic variables in both cohorts were analyzed.The study enrolled 881 patients. For the patients with low-risk IBC, the annual rates of radiotherapy were stable from 2012 to 2019. However, radiotherapy utilization decreased significantly from 2020 to 2022 (58% in 2012 vs 36% in 2022; p = 0.04). In contrast, radiotherapy usage among the patients with high-risk IBC was stable from 2012 to 2022 (79% in 2012 vs 79% in 2022; p = 0.95). Among the patients with low-risk IBC, SLNB rates decreased from 86% in 2012 to 56% in 2022, but this trend predated those in 2020. The factors significantly associated with SLNB and receipt of radiotherapy among the patients with low-risk IBC were younger age, larger tumors, grade 3 disease, and involved nodal status (p < 0.01).This study demonstrated appropriate and sustained de-escalation of radiotherapy in older women with low-risk IBC after the COVID-19 pandemic.© 2023. The Author(s).