Breast Cancer Research and Treatment

, Volume 34, Issue 1, pp 77–83 | Cite as

Should tamoxifen be a primary treatment choice for elderly breast cancer patients with locoregional disease?

  • L. Bergman
  • J. A. van Dongen
  • B. van Ooijen
  • F. E. van Leeuwen
Report

Summary

To determine the efficacy of tamoxifen as primary treatment for elderly breast cancer patients with locoregional disease, the medical records of 85 patients of 75 years and older were reviewed. The median follow-up was 28 months (range 3–97 mo). Complete remission occurred in twelve (14.1%) patients. All of these patients remained in remission until death or closing date of the study. Twenty (23.5%) patients responded with a partial remission; 5 of them subsequently developed tumor progression. Thirteen (15.3%) patients developed initial tumor progression and 39 (45.9%) had disease stabilisation. Nineteen of this latter group subsequently developed tumor progression. Out of 37 (43.5%) patients with tumor progression, 14 patients were salvaged by surgery (n = 13) or radiotherapy (n = 1). Until the closing date of the study, disease could not be controlled by secondary treatment in 12 patients who subsequently died of breast cancer. Twenty-two of the 37 patients were unfit for surgical treatment at progression, of whom 14 were operable at diagnosis. The actuarial 5-year observed survival rate was 40% for the whole patient group.

Conclusions: Although some patients (14.1%) managed to maintain a long lasting complete remission, caution should be preserved in using tamoxifen as first-line treatment, because of the high risk of treatment failures. As long as factors can not be identified to predict which subgroups of patients will respond to tamoxifen with a remission lasting for their life-time, tamoxifen may only provide an acceptable alternative for elderly breast cancer patients who are too frail or are unwilling to undergo surgery or radiotherapy. For elderly patients in good physical condition, primary treatment by tamoxifen only delays definitive surgical treatment.

Key words

breast cancer elderly tamoxifen treatment 

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References

  1. 1.
    McCarty KS, Silva JS, Cox EB, Leight GS, Wells SA: Relationship of age and menopausal status to oestrogen receptor content in primary carcinoma of the breast. Ann Surg 197: 123–127, 1983Google Scholar
  2. 2.
    Akhtar SS, Allan SG, Rodger A, Chetty UDI, Smyth JF, Leonard RCF: A 10-year experience of tamoxifen as primary treatment of breast cancer in 100 elderly and frail patients. Eur J Surg Onc 17: 30–35, 1991Google Scholar
  3. 3.
    Bradbeer JW, Kyngdon J: Primary treatment of breast cancer in elderly women with tamoxifen. Clin Oncol 9: 31–34, 1983Google Scholar
  4. 4.
    Gazet J-C, Ford HT, Bland JM, Markopaulos CH, Coombes RC, Dixon RC: Prospective randomised trial of tamoxifen versus surgery in elderly patients with breast cancer. Lancet ii: 679–681, 1988Google Scholar
  5. 5.
    Robertson JFR, Ellis IO, Elston CW, Blamey RW: Mastectomy or tamoxifen as initial therapy for operable breast cancer in elderly patients: 5-year follow-up. Eur J Cancer 28A: 908–910, 1992Google Scholar
  6. 6.
    Horobin JM, Preece PE, Dewar JA, Wood RAB, Cuschieri A: Long-term follow-up of elderly patients with locoregional breast cancer treated with tamoxifen only. Br J Surg 78: 213–217, 1991Google Scholar
  7. 7.
    Hayward JL, Carbone PP, Heuson J-C, Kumaoka S, Segaloff A, Rubens RD: Assessment of response to therapy in advanced breast cancer. Cancer 39: 1289–1294, 1977Google Scholar
  8. 8.
    Nolvadex Adjuvant Trial Organisation: Controlled trial of tamoxifen as single adjuvant agent in management of early breast cancer. Lancet i: 836–840, 1985Google Scholar

Copyright information

© Kluwer Academic Publishers 1995

Authors and Affiliations

  • L. Bergman
    • 1
  • J. A. van Dongen
    • 2
  • B. van Ooijen
    • 3
  • F. E. van Leeuwen
    • 1
  1. 1.Department of EpidemiologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
  2. 2.Division of SurgeryThe Netherlands Cancer InstituteAmsterdamThe Netherlands
  3. 3.Department of Surgical OncologyDr. Daniel den Hoed Cancer CenterRotterdamThe Netherlands

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