TAMOXIFEN IN BREAST-CONSERVATION THERAPY

Breast conservation surgery for early breast cancer requires post-oper ative radiotherapy to give local control rates equivalent to mastectom y. Three hundred and thirty-five women presenting with symptomatic bre ast lumps and receiving radiotherapy and adjuvant systemic therapy at St. Bartholomew's, have actuarial 8-year local relapse-free rates of 9 0% for T-1 and 83% for T-2,T-3 presenting cases. Amongst 49 elderly an d/or medically frail patients treated with a similar surgical policy b ut post-operative tamoxifen only (for standard risk features), the loc al relapse-free rates were 96% for T-1 and 43% for T-2,T-3 Most relaps es occurred in the first 2 years in both groups. We conclude that, in the absence of high risk features (defined), breast conservation surge ry and tamoxifen only is a safe option for T-1 disease in the elderly, but that the risk of local relapse is considerably higher when this p olicy is employed for patients presenting with larger tumors.