Alternative therapy for elderly patients with breast cancer.
Breast cancer treatment has undergone significant changes in concept, concurrent with alterations in our understanding of cancer biology and natural history. Within the last 10 years, oncologists have brought into question the traditional Halstedian concepts of the natural history of breast cancer and its appropriate management. The goal of treatment, once a primary cancer is detected in the breast, is to prevent metastasis and subsequent death of the patient. One hundred forty-two female patients over the age of 65 with histologically confirmed breast cancer were treated at Lankenau Hospital from 1982 to 1990. We treated 32 women over the age of 65 with quadrantectomy and tamoxifen as the sole form of therapy. No radiation, standard chemotherapy, nor axillary dissection was utilized. A cohort of 110 women of similar age, treated for breast cancer with "standard therapy" (total mastectomy or "segmental resection" and radiation with axillary nodal dissection) during the same time period, were also analyzed retrospectively. All segmental resections were followed by standard radiation doses to the ipsilateral breast and draining nodal basins with a local boost. Twenty-nine of 32 patients in the quad + tam group were available for follow-up 1 to 8 years following treatment (mean 52 months). The cumulative overall survival was 67 per cent and disease-free survival 92 per cent. No patient developed local recurrence. Follow-up analysis of the 110 women treated in "standard fashion" was complete in 88 patients 1 to 8 years post-treatment (mean 56 months). Cumulative overall survival was 82 per cent and disease-free survival 83 per cent. Local recurrence was noted in five per cent.(ABSTRACT TRUNCATED AT 250 WORDS)
von Rueden
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Division of General Surgery, Lankenau Hospital, Wynnewood, Pennsylvania 19096.
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D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D002278:Carcinoma in Situ / Q000188:drug therapy / Q000473:pathology / Q000556:secondary / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy / Q000473:pathology / Q000556:secondary / Q000601:surgery; D018275:Carcinoma, Lobular / Q000188:drug therapy / Q000473:pathology / Q000556:secondary / Q000601:surgery; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D015412:Mastectomy, Segmental / Q000379:methods*; D015413:Mastectomy, Simple; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000473:pathology; D011960:Receptors, Estrogen / Q000032:analysis; D011980:Receptors, Progesterone / Q000032:analysis; D012189:Retrospective Studies; D015996:Survival Rate; D013629:Tamoxifen / Q000008:administration & dosage / Q000627:therapeutic use*
D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; D013629:Tamoxifen