10-YEAR RESULTS OF THE TREATMENT OF EARLY-STAGE BREAST-CARCINOMA IN ELDERLY WOMEN USING BREAST-CONSERVING SURGERY AND DEFINITIVE BREAST IRRADIATION

Purpose: The optimal management of breast cancer in elderly women is n ot well established. Therefore, the present study was undertaken to ev aluate the outcome of breast cancer in elderly women treated with brea st-conserving surgery and definitive breast irradiation. Methods and M aterials: An analysis was performed of 558 women age greater than or e qual to 50 years treated with breast-conserving surgery and definitive breast irradiation for Stages I-II invasive carcinoma of the breast. Of the 558 total women, there were 173 elderly women age greater than or equal to 65 years and a comparison group of 385 women age 50-64 yea rs, Treatment for all women included complete gross excision of the pr imary tumor, pathologic axillary lymph node staging, and definitive br east irradiation. Adjuvant systemic chemotherapy was used in 18% (102 out of 558) of the overall group. Adjuvant tamoxifen was used in 17% ( 94 out of 558) of the overall group. The median follow-up after treatm ent was 6.2 years (mean = 6.4 years; range = 0.1-15.4 years). Results: Elderly patients age greater than or equal to 65 years and patients a ge 50-64 years were both found to have tumors with adverse prognostic features, including clinical T2 lesions (43 vs. 34%, respectively; p = 0.055), estrogen receptor negativity (9 vs. 16%, respectively; p = 0. 13), and progesterone receptor negativity (17 vs. 21%, respectively;p = 0.50). Pathologic axillary lymph node staging showed that 24% of the elderly women were node positive, including 8% with four or more posi tive nodes, which was not different from women age 50-64 years (p = 0. 23). There was no difference between the two age groups for the rate o f deaths from breast cancer at 10 years (13 vs. 13%, respectively; p = 0.71). However, there was a significant difference between the two ag e groups for the rate of deaths from intercurrent disease at 10 years (11 vs. 2%, respectively; p = 0.0006). There were no differences betwe en the two age groups for the 10-year rates of overall survival (77 vs . 85%, respectively; p = 0.14), relapse-free survival (64 vs. 70%, res pectively; p = 0.16), freedom from distant metastases (83 vs. 78%, res pectively; p = 0.45), or local failure (13 vs. 12%, respectively; p = 0.60). Conclusions: These results have shown that breast carcinomas in elderly women are not indolent and have a number of adverse prognosti c features. Breast-conserving surgery and definitive breast irradiatio n in elderly women age greater than or equal to 65 years achieves good outcomes for survival, freedom from distant metastases, and local con trol, which are comparable to women age 50-64 years. The causes of dea ths in elderly women age greater than or equal to 65 gears are from bo th breast cancer and intercurrent disease. Breast-conserving surgery a nd definitive breast irradiation should continue to be considered as a standard treatment option for appropriately selected elderly women wi th early-stage breast cancer.