Surgery versus primary endocrine therapy for elderly women with estrogen receptor-positive early operable primary breast cancer: Survival analysis and correlation with oestrogen receptor positivity

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 612-612
Author(s):  
B. M. Syed ◽  
S. J. Johnston ◽  
D. W. M. Wong ◽  
D. A. L. Morgan ◽  
I. O. Ellis ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Primary Breast Cancer ◽  
Oestrogen Receptor ◽  
Elderly Women ◽  
Breast Cancer Specific Survival ◽  
Cancer Specific Survival ◽  
Er Positive ◽  
Primary Endocrine Therapy

612 Background: A recent Cochrane review of seven randomised trials involving 1,446 elderly women (unselected for oestrogen receptor (ER) status) has shown no significant difference in overall survival between surgery (with or without adjuvant tamoxifen) and primary endocrine therapy using tamoxifen. We now report results of a large series from a single centre with a dedicated elderly breast cancer service, with long term follow-up. Methods: During a period of > 20 years, 1,031 elderly (> 70 years) women with ER positive (H-score >50) early operable primary breast cancer received either surgery (with or without adjuvant endocrine therapy) (N = 436) or primary endocrine therapy (N = 595) (>80% using tamoxifen) as initial treatment, with complete follow-up information till deaths. The initial treatment was decided based on fitness for surgery and patient choice. Analysis was carried out on breast cancer specific survival and degree of ER positivity. Results: After a median follow up of 49 months (range 0 - 261 months), patients between 70 - 80 years, treated by surgery, had better 5-year breast cancer specific survival compared to their counterparts treated by primary endocrine therapy (95% versus 85%; p < 0.001). For patients > 80 years, there was however no statistical difference between the two groups (90% versus 90%; p = 0.813). The median survival has not reached yet in all groups. Patients in the latter group (> 80 years) were found to have a higher chance of having strongly ER positive tumours (57% versus 50% in patients between 70 - 80 years with H-score >200; p- < 0.02). Conclusions: In a selected group of elderly women (> 80 years) who tend to have strongly ER positive tumours, surgery and primary endocrine therapy did not appear to produce any difference in breast cancer specific survival. This subject is currently being investigated in a national randomised trial in the UK. No significant financial relationships to disclose.

scholarly journals Is primary endocrine therapy effective in treating the elderly, unfit patient with breast cancer?

2011 ◽  
Vol 93 (4) ◽  
pp. 286-289 ◽  
Author(s):  
G Osborn ◽  
M Jones ◽  
C Champ ◽  
K Gower-Thomas ◽  
E Vaughan-Williams
Keyword(s):  
Breast Cancer ◽  
Disease Progression ◽  
Endocrine Therapy ◽  
General Anaesthetic ◽  
Number Of Patients ◽  
Co Morbidity ◽  
Er Positive ◽  
Primary Endocrine Therapy ◽  
Positive Breast Cancer

INTRODUCTION Elderly patients with oestrogen receptor (ER)-positive breast cancer wishing to avoid surgery or those who are considered unsuitable for a general anaesthetic may be treated with primary endocrine therapy. We have reviewed all patients with ER-positive breast cancer who were initially treated with primary hormone therapy (PHT) at a district general hospital in south Wales and investigated their outcome in order to evaluate the appropriateness of this method of managing breast cancer. MATERIALS AND METHODS All patients with breast cancer who were initially treated with PHT between January 2002 and December 2008 were identified from a single consultant's prospectively maintained database. For each patient the Charlson co-morbidity index was calculated to give an estimate of ten-year survival. Patients who had died during the study period were identified from hospital and cancer registries. RESULTS A total of 83 cancers in 82 patients with a median age of 81 years (range: 62–93 years) were included. All cancers were ER-positive. Six patients (7%) had a greater than 50% chance of surviving ten years, calculated using the Charlson index. The median follow-up period was 24 months (range: 6–72 months). Twelve patients (15%) had disease progression while taking PHT. Twenty-three patients (28%) have died (median time from diagnosis to death of 10.5 months, range: 1–77 months). Two patients (2%) experienced disease progression within six months of starting PHT and the number of patients whose cancer progressed increased with increasing length of follow up. Fourteen patients (17%) eventually underwent a wide local excision under local anaesthetic. CONCLUSIONS PHT can be considered an effective treatment in this elderly, unfit population with the aim of stopping disease progression so that these patients die with their breast cancer, not of it.

scholarly journals Lumpectomy Plus Tamoxifen With or Without Irradiation in Women Age 70 Years or Older With Early Breast Cancer: Long-Term Follow-Up of CALGB 9343

2013 ◽  
Vol 31 (19) ◽  
pp. 2382-2387 ◽  
Author(s):  
Kevin S. Hughes ◽  
Lauren A. Schnaper ◽  
Jennifer R. Bellon ◽  
Constance T. Cirrincione ◽  
Donald A. Berry ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Distant Metastasis ◽  
Early Stage ◽  
Breast Cancer Specific Survival ◽  
Cancer Specific Survival ◽  
Er Positive ◽  
Long Term Follow Up

Purpose To determine whether there is a benefit to adjuvant radiation therapy after breast-conserving surgery and tamoxifen in women age ≥ 70 years with early-stage breast cancer. Patients and Methods Between July 1994 and February 1999, 636 women (age ≥ 70 years) who had clinical stage I (T1N0M0 according to TNM classification) estrogen receptor (ER) –positive breast carcinoma treated by lumpectomy were randomly assigned to receive tamoxifen plus radiation therapy (TamRT; 317 women) or tamoxifen alone (Tam; 319 women). Primary end points were time to local or regional recurrence, frequency of mastectomy, breast cancer–specific survival, time to distant metastasis, and overall survival (OS). Results Median follow-up for treated patients is now 12.6 years. At 10 years, 98% of patients receiving TamRT (95% CI, 96% to 99%) compared with 90% of those receiving Tam (95% CI, 85% to 93%) were free from local and regional recurrences. There were no significant differences in time to mastectomy, time to distant metastasis, breast cancer–specific survival, or OS between the two groups. Ten-year OS was 67% (95% CI, 62% to 72%) and 66% (95% CI, 61% to 71%) in the TamRT and Tam groups, respectively. Conclusion With long-term follow-up, the previously observed small improvement in locoregional recurrence with the addition of radiation therapy remains. However, this does not translate into an advantage in OS, distant disease-free survival, or breast preservation. Depending on the value placed on local recurrence, Tam remains a reasonable option for women age ≥ 70 years with ER-positive early-stage breast cancer.

Biological characteristics of oestrogen receptor positive early operable primary breast cancer in the elderly

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 10739-10739
Author(s):  
M. W. Ying ◽  
A. R. Green ◽  
A. Agrawal ◽  
C. E. Paish ◽  
D. A. Morgan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Breast Cancer ◽  
Oestrogen Receptor ◽  
The Elderly ◽  
Biological Characteristics ◽  
Her2 Status ◽  
Her2 Positive ◽  
Er Positive ◽  
Her2 Positivity

10739 Background: Over half of breast cancer are diagnosed at >65 years and increasingly more are diagnosed in the elderly population. However little is known about their biological characteristics, which may be important in therapeutic strategies such as selecting endocrine agents as primary, neoadjuvant or adjuvant therapy. We report the pattern of oestrogen receptor (ER), progesterone receptor (PgR) and HER2 status in a cohort of elderly patients with primary breast cancer (PBC). Methods: All elderly (> 70 years) patients, who had ER positive early operable PBC (< 5 cm) and who refused or were unfit for surgery, were treated with primary endocrine therapy. Standard immunohistochemical staining was performed on core biopsy tumour tissuefor ER, PgR and HER2. Positivity for ER and PgR was defined by H-score ≥ 50, and HER2 positivity was defined as 3+. Results: A total of 86 such patients were treated over a two-year period and the biological characteristics of their tumours were as follows (see Table ). Conclusions: Within the group of ER positive patients, approximately half of the tumours also expressed PgR. The total number of HER2 positive tumours was small although the majority of these were PgR negative. Clinical follow-up is ongoing to elucidate the relationship between endocrine sensitivity and these biological characteristics. [Table: see text] [Table: see text]

scholarly journals Breast cancer-specific survival by clinical subtype after 7 years follow-up of young and elderly women in a nationwide cohort

2018 ◽  
Vol 144 (6) ◽  
pp. 1251-1261 ◽  
Author(s):  
Anna L.V. Johansson ◽  
Cassia B. Trewin ◽  
Kirsti Vik Hjerkind ◽  
Merete Ellingjord-Dale ◽  
Tom Børge Johannesen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Elderly Women ◽  
Breast Cancer Specific Survival ◽  
Cancer Specific Survival ◽  
Clinical Subtype
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