Researchers have shown that in women 70 years of age or older with early breast cancer undergoing lumpectomy, tamoxifen alone (Tam) is an effective alternative to tamoxifen plus radiation (TamRT). The initial results were based on a median follow-up (FU) of 7.9 years.

Results of the follow-up study which will be presented at ASCO provides longer-term results outcomes at a median FU of 10.5 years. This follow-up study adds further evidence that women age 70 or older with early-stage breast cancer who undergo lumpectomy and receive tamoxifen may safely forego radiation therapy without significantly affecting their survival.

?The standard of care for women 70 and older with very small tumors that are estrogen-positive and node-negative ? the largest group of breast cancer patients in this age group ? had been lumpectomy and radiation,? said lead author Kevin Hughes, MD, surgical director, breast screening, and co-director of the Avon Comprehensive Breast Evaluation Center at the Massachusetts General Hospital in Boston.

?Earlier reports of this study with shorter median follow-up have shown the risk of recurrence without radiation to be only marginally worse than with radiation, but there was concern that longer follow-up would show a blossoming of recurrences. This study confirms that for older women with early-stage breast cancer, lumpectomy without radiation is a viable alternative, and tamoxifen may replace the need for radiation.?

Radiation therapy after lumpectomy is the standard of care for younger women with early-stage breast cancer. Dr. Hughes and his colleagues looked at whether this therapy is also appropriate for older women, who often have less aggressive disease and are less likely to experience a recurrence.

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Between July 1994 and February 1999 the researchers randomly assigned 636 women aged 70 or older with stage I, estrogen receptor-positive,node-negative breast cancer who had a lumpectomy to receive tamoxifen (319 women) or tamoxifen and radiation (317 women). An earlier analysis by these investigators showed that after a median follow-up of 7.9 years, tamoxifen alone was an effective alternative to tamoxifen and radiation. This new analysis includes follow-up data after 10.5 years.

The risk of breast cancer recurrence in the same breast was lower among the women who received tamoxifen plus radiation therapy (2%) compared with those who received tamoxifen alone (8%). However, there were no significant differences between the two groups with respect to breast cancer-specific and overall survival: After 10 years, breast cancer-specific survival for women who received tamoxifen was 98% versus 96% for those who received tamoxifen and radiation.

The tamoxifen-only group had a 10-year overall survival of 63% compared to 61% to the tamoxifen plus radiation group.

Oral Abstract Session: Breast Cancer ? Local, Regional and Adjuvant Therapy
Lead author: Kevin Hughes, MD, Massachusetts General Hospital, Boston, MA
Date: Monday, June 7, 2010, 10:15-10:30 AM CDT, N Hall B1
Abstract: 507
Title: Lumpectomy plus tamoxifen with or without irradiation in women age 70 or older with early breast cancer.
Authors: K. S. Hughes, L. A. Schnaper, C. Cirrincione, D. A. Berry, B. McCormick, H. B. Muss, B. Shank, C.Hudis, E. P. Winer, B. L. Smith, CALGB, ECOG, RTOG.

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