Long-term follow-up of elderly patients with operable breast cancer treated with surgery without axillary dissection plus adjuvant tamoxifen

Abstract

al., 1988) comparing surgery with tamoxifen did not find a difference in survival between the two groups but locoregional control led to a better result in the surgically treated patients. This led to the conclusion that optimum treatment for elderly patients could include both surgery and tamoxifen. A randomised study (Bates et al., 1991) compared tamoxifen only with optimal surgery followed by adjuvant tamoxifen. The overall survival after 3 years was similar between the two groups but a statistically significant higher locoregional relapse rate was reported in the group treated by tamoxifen only.The rationale of the present study was that non-randomised clinical studies (Helleberg et al., 1982;Preece et al., 1982;Allan et al., 1985) showed that tamoxifen as first-line treatment was of value in a selected group of elderly breast cancer patients. The question was whether surgery without axillary dissection combined with tamoxifen in patients with breast cancer and without clinical nodal involvement could give the same results in terms of overall survival, disease-free survival and quality of life compared with more radical treatments.In a previous paper (Martelli et al., 1993) (Hermanek et al., 1987), 77 (24%) a T2, 1 (0.3%) a T3 and 24 patients (7.5%) presented with a tumour infiltrating the skin but not the underlying muscle (T4b). All patients had surgery performed under local anaesthesia without axillary dissection; 298 underwent wide lumpectomy or quadrantectomy and 23 total mastectomy. The conservative surgical techniques have been previously described (Veronesi et al., 1990;Galante et al., 1992).All patients underwent resection of the tumour with removal of at least 2 cm of normal tissue to ensure a specimen with tumour-free margins. Patients with the margins of resection in tumour tissue were excluded from the analysis, since they were candidates for a re-excision or radiotherapy.Independent of hormone receptor status, all patients received indefinitely 20 mg tamoxifen daily from the time of surgery. Tumour specimens were assayed for both oestrogen receptor (ER) and progesterone receptor (PgR) levels by using the dextran-coated charcoal Scatchard analysis. RecepCorrespondence: G Martelli

Variations in breast carcinoma treatment in older medicare beneficiaries

“…22,56 The use of radiotherapy among older breast carcinoma patients is now the subject of clinical investigation and shifting clinical paradigms. 57,58 However, despite scientific uncertainty as to the most appropriate treatment for older women, it appears that, in the past, some black women may have been undertreated according to prevailing standards. 55 There are several caveats that should be considered in evaluating our results, including the use of 1994 cases, focus on the fee-for-service sector, power and absolute differences in effects, use of area measures, post hoc assessment of attitudes, reliance on claims, and difficulty in controlling for unmeasured or unobservable patient and/or race-related characteristics that affected treatment.…”

Cell‐Penetrating Peptides as Delivery Vehicles for a Protein‐Targeted Terbium Complex

“…Black women are also more likely to have a less favorable pattern of disease recurrence than whites, with associated decrements in quality of life 22, 56. The use of radiotherapy among older breast carcinoma patients is now the subject of clinical investigation and shifting clinical paradigms 57, 58. However, despite scientific uncertainty as to the most appropriate treatment for older women, it appears that, in the past, some black women may have been undertreated according to prevailing standards 55…”

Management of Breast Cancer in the Elderly by Complete Local Excision and Tamoxifen Alone

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