Abstract
The purpose of this study was the evaluation of the necessity of routinely applied postoperative radiotherapy in a highly selected patient-group after breast conserving surgery. Between 1983 and May 1994, 356 women over 60 years of age with Stage I or II breast cancer were treated by quadrantectomy and axillary dissection followed by either adjuvant irradiation or no radiotherapy. We have analysed our data retrospectively to investigate whether irradiation has any benefit in elderly patients with respect to locoregional recurrence rates. After a median follow-up of 60 months the multivariate model revealed lymph node status (p=0.002) as highly significant with regard to local recurrence free survival. We were not able to identify a positive effect of adjuvant irradiation in patients with negative lymph nodes and positive receptor status: both patient groups with or without irradiation had similar locoregional recurrence rates of 3%. In a subgroup of patients who were lymph node negative, receptor positive, and received adjuvant tamoxifen therapy, the local recurrence rates were as low as 2% in both groups. Concerning these results it may be possible to avoid the morbidity and potential psychological side effects of radiotherapy in breast cancer patients over 60 years of age treated by breast conserving surgery (T1, N0, positive hormone receptor, adjuvant tamoxifen) without increasing risk of locoregional recurrence. These data have to be confirmed in a prospectively randomized fashion.
Similar content being viewed by others
References
Fisher B, Bauer M, Margolese R, Poisson R, Pilch Y, Redmond C, Fisher ER, Wolmark N, Deutsch M, Montague E, Saffer E, Wickerham L, Lerner H, Glass A, Shibata H, Deckers P, Ketcham A, Oishi R, Russell I: Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer. N Engl J Med 312: 665–673, 1985
Fisher B, Redmond C, Poisson R, Margolese R, Wolmark N, Wickerham L, Fisher ER, Deutsch M, Caplan R, Pilch Y, Glass A, Shibata H, Lerner H, Terz J, Sidorovich L: Eight-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without irradiation in the treatment of breast cancer. N Engl J Med 320: 822–828, 1989
Veronesi U, Banfi A, Salvadori B, Luini A, Saccozzi R, Zucali R, Marubini E, Del Vecchio M, Boracchi P, Marchini S, Merson M, Sacchini V, Riboldi G, Santoro G: Breast conservation is the treatment of choice in small breast cancer: long-term results of a randomized trial. Eur J Cancer 26: 668–670, 1990
Veronesi U, Volterrani F, Luini A, Saccozzi R, Del Vecchio M, Zucali R, Galimberti V, Rasponi A, Di Re E, Squicciarini P, Salvadori B: Quadrantectomy versus lumpectomy for small size breast cancer. Eur J Cancer 26: 671–673, 1990
Fisher B, Anderson S, Fisher ER, Redmond C, Wickerham DL, Wolmark N, Mamounas EP, Deutsch M, Margolese R: Significance of ipsilateral breast tumor recurrence after lumpectomy. Lancet 338: 327–331, 1991
Veronesi U, Luini A, Del Vecchio M, Greco M, Galimberti V, Merson M, Rilke F, Sacchini V, Saccozzi R, Savio T, Zucali R, Zurrida S, Salvadori B: Radiotherapy after breast-preserving surgery in women with localized cancer of the breast. N Engl J Med 328: 1587–1591, 1993
Hermann RE, Esselstyn CB, Grundfest-Broniatowski S, Steiger E, Vogt DP, Broughan TA, Dowden RV, Hardesty I, Medendrop SV, Boyett JM: Partial mastectomy without radiation is adequate treatment for patients with Stage 0 and 1 carcinoma of the breast. Surg Gyn Obst 177: 247–253, 1993
Liljegren G, Homberg L, Adami HO, Westerman G, Graffman S, Bergh J: Sector resection with or without postoperative radiotherapy for Stage I breast cancer: five-year results of a randomized trial. J Natl Cancer Inst 86: 717–722, 1994
Locker AP, Ellis IO, Morgan DAL, Elston CW, Mitchell A, Blamey RW: Factors influencing local recurrence after excision and radiotherapy for primary breast cancer. Br J Surg 76: 890–894, 1989
Carter CL, Allen C, Henson DE: Relation of tumor size, lymph node status, and survival in 24,740 breast cancer cases. Cancer 63: 181–187, 1989
Clark RM, McCulloch PB, Levine MN, Lipa M, Wilkinson RH, Mahoney LJ, Basrur VR, Nair BD, McDermot RS, Wong CS, Corbett PJ: Randomized clinical trial to assess the effectiveness of breast irradiation following lumpectomy and axillary dissection for node-negative breast cancer. J Natl Cancer Inst 84: 683–689, 1992
Greening WP, Montgomery ACV, Gordon AB, Growing NFC: Quadrantic excision and axillary node dissection without radiation therapy: the long-term results of a selective policy in the treatment of Stage I breast cancer. Eur J Surg Onc 14: 221–225, 1988
Fisher ER, Anderson S, Redmond C, Fisher B: Ipsilateral breast tumor recurrence and survival following lumpectomy and irradiation: pathological findings from NSABP Protocol B-06. Sem Surg Onc 8: 161–166, 1992
Kurtz JM, Jacquemier J, Amalric R, Brandone H, Ayme Y, Hans D, Bressac C, Roth J, Spitalier JM: Risk factors for breast recurrence in premenopausal and postmenopausal patients with ductal cancers treated by conservation therapy. Cancer 65: 1867–1878, 1990
Fourquet A, Campana F, Zafrani B: Prognostic factors of breast recurrence in the conservative management of early breast cancer: A 25-year follow-up. Int J Radiat Oncol Biol Phys 17: 719–725, 1989
Borger J, Kemperman H, Hart A, Peterse H, van Dongen J, Bartelink H: Risk factors in breast-conservation therapy. J Clin Oncol 12: 653–660, 1994
Schnitt SJ, Connolly JL, Harris JR, Hellman S, Cohen RB: Pathological predictors of early recurrence in Stage I and II breast cancer treated by primary radiation therapy. Cancer 53: 1049–1057, 1984
Fisher ER, Redmond C, Fisher B, Bass G: Pathologic findings from the National Surgical Adjuvant Breast and Bowel Projects (NSABP). Cancer 65: 2121–2128, 1990
Fisher B, Constantino J, Redmond C, Poisson R, Bowman D, Couture J, Dimitrov NV, Wolmark N, Wickerham DL, Fisher ER, Margolese R, Robidoux A, Shibata H, Terz J, Paterson AHG, Feldman MI, Farrar W, Evans J, Lickley HL, Ketner M: A randomized clinical trial evaluating Tamoxifen in the treatment of patients with node-negative breast cancer who have estrogen-receptor-positive tumors. N Engl J Med 320: 479–484, 1989
Holland R, Connolly JL, Gelman R, Mravunac M, Hendriks J, Verbeek A, Schnitt SJ, Silver B, Boyages J, Harris JR: The presence of an intraductal component following a limited excision correlates with prominent residual disease in the remainder of the breast. J Clin Oncol 8: 113–118, 1990
Clemente CG, Boracchi P, Andreola S, Del Vecchio M, Veronesi P, Rilke FO: Peritumoral lymphatic invasion in patients with node-negative mammary duct carcinoma. Cancer 69: 1396–1403, 1992
Gruenberger Th, Gorlitzer M, Soliman Th, Rudas M, Mittlboeck M, Goetzinger P, Gnant M, Reiner A, Teleky B, Seitz W, Jakesz R: Kann man einer hochselektionierten Patientinnengruppe nach brusterhaltender Therapie wegen Mammakarzinoms die postoperative Nachbestrahlung ersparen? Acta Chirurgica Austriaca 27: 269–273, 1995
Nemoto T, Patel JK, Rosner D, Dao TL, Schuh M, Penetrante R: Factors affecting recurrence in lumpectomy without irradiation for breast cancer. Cancer 67: 2079–2082, 1991
Recht A, Houlihan MJ: Conservative surgery without radiotherapy in the treatment of patients with early-stage invasive breast cancer. Ann Surg 222: 9–18, 1995
Reiner A, Spona J, Reiner G: Estrogen receptor analysis on biopses and fine-needle aspirates from human breast carcinoma. Am J Pathol 125: 443–449, 1986
Fisher B, Anderson S, Redmond CK, Wolmark N, Wickerham DL, Cronin WM: Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med 333: 1456–1461, 1995
Clark RM, Whelan T, Levine M, Roberts R, Willan A, McCulloch P, Lipa M, Wilkinson RH, Mahoney LJ: Randomized clinical trial of breast irradiation following lumpectomy and axillary dissection for node-negative breast cancer: an update. J Natl Cancer Inst 88: 1659–1664, 1996
Forrest AP, Stewart HJ, Everington D, Prescott RJ, McArdle CS, Harnett AN, Smith DC: Randomized controlled trial of conservation therapy for breast cancer: 6-year analysis of the Scottish trial. Lancet 348: 708–713, 1996
Liljegren G, Lindgren A, Bergh J, Nordgren H, Tabar L, Holmberg L: Risk factors for local recurrence after conservative treatment in stage I breast cancer. Definition of a subgroup not requiring radiotherapy. Ann Oncology 8: 235–241, 1997
Moffat FL, Ketcham AS, Robinson DS, Legaspi A, Ghandur-Mnaymneh L, Hilsenbeck S: Segmental mastectomy without radiotherapy for T1 and small T2 breast carcinomas. Arch Surg 125: 364–369, 1990
Cady B, Stone MD, Wayne J: New therapeutic possibilities in primary invasive breast cancer. Ann Surg 218: 338–349, 1993
Dalberg K, Mattsson A, Rutqvist LE, Johansson U, Riddez L, Sandelin K: Breast conserving surgery for invasive breast cancer: Risk factors for ipsilateral breast tumor recurrences. Breast Cancer Res Treat 43: 73–86, 1997
van Dongen JA, Bartelink H, Fentiman IS, Lerut T, Mignolet F, Olthuis G, van der Schueren E, Tong D, Winter J, van Zijl K: Factors influencing local relapse and survival and results of salvage treatment after breast-conserving therapy in operable breast cancer: EORTC trial 10801, breast conservation compared with mastectomy in TNM stage I and II breast cancer. Eur J Cancer 28A(4/5): 801–805, 1992
Stewart HJ, Prescott RJ, Forrest PA: Conservation therapy of breast cancer. Lancet ii 168–169, 1989
Early Breast Cancer Trialists' Collaborative Group: Systemic treatment of early breast cancer by hormonal, cytotoxic, or immune therapy. Lancet 339: 71–85, 1992
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Gruenberger, T., Gorlitzer, M., Soliman, T. et al. It is possible to omit postoperative irradiation in a highly selected group of elderly breast cancer patients. Breast Cancer Res Treat 50, 37–46 (1998). https://doi.org/10.1023/A:1006064608360
Issue Date:
DOI: https://doi.org/10.1023/A:1006064608360