Long-term results of hypofractionated radiotherapy and hormonal therapy without surgery for breast cancer in elderly patients.
OBJECTIVE
To evaluate early and late reactions, local control, disease-free survival, cause-specific survival, and overall survival of elderly breast cancer patients treated with definitive once-a-week hypofractionated radiotherapy together with hormonal therapy.


METHODS
Between 1987 and 1999, 115 patients with a median age of 83 presenting with 124 non-metastatic breast carcinoma were treated with definitive once weekly hypofractionated radiotherapy associated with hormonal therapy. The main reasons for adopting this schedule were patient refusal of surgery, very old age, locally advanced case, and/or comorbid disease. Radiation was delivered as once-a-week, 6.5 Gy for a total breast dose of 32.5 Gy in five fractions, followed with 1-3 fractions of 6.5 Gy to the tumour site. The median follow-up was 41 months.


RESULTS
Neoadjuvant hormonal therapy led to 56% reduction of the tumour volume. Late reactions occurred in 46 patients; they were mild to moderate in 87% of these patients. The Kaplan-Meier rate was 52% of patients, with 6% experiencing grade 3 reactions. The 5-year local progression-free rate was 78%. The corresponding cause-specific survival was 71%, and was influenced by T classification, nodal status, oestrogen receptors and the total dose. The first three factors retained an independent prognostic impact on multivariate analysis. The 5-year overall survival was 38%. It was affected by the T classification, lymph node involvement and the performance status (PS). Using a multivariate analysis, only T classification and PS were identified as independent factors regarding overall survival.


CONCLUSIONS
Definitive hypofractionated radiotherapy allows a good local control, with acceptable toxicity. This schedule associated with hormonal therapy is a good alternative to surgery in non-operable old patients and in case of patient refusal to surgery and to standard fractionation.
Courdi
Adel
A
Radiotherapy Department, Centre Antoine-Lacassagne, Nice Cedex, France. adel.courdi@nice.fnclcc.fr
Ortholan
Cécile
C
Hannoun-Lévi
Jean-Michel
JM
Ferrero
Jean-Marc
JM
Largillier
Rémy
R
Balu-Maestro
Catherine
C
Chapellier
Claire
C
Ettore
Francette
F
Birtwisle-Peyrottes
Isabelle
I
D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D020360:Neoadjuvant Therapy; D011960:Receptors, Estrogen / Q000378:metabolism; D012307:Risk Factors; D016019:Survival Analysis
D018931:Antineoplastic Agents, Hormonal; D011960:Receptors, Estrogen