IT IS POSSIBLE TO OMIT POSTOPERATIVE IRRADIATION IN A HIGHLY SELECTEDGROUP OF ELDERLY BREAST-CANCER PATIENTS

The purpose of this study was the evaluation of the necessity of routi nely applied postoperative radiotherapy in a highly selected patient-g roup after breast conserving surgery. Between 1983 and May 1994, 356 w omen over 60 years of age with Stage I or II breast cancer were treate d by quadrantectomy and axillary dissection followed by either adjuvan t irradiation or no radiotherapy. We have analysed our data retrospect ively to investigate whether irradiation has any benefit in elderly pa tients with respect to locoregional recurrence rates. After a median f ollow-up of 60 months the multivariate model revealed lymph node statu s (p = 0.002) as highly significant with regard to local recurrence fr ee survival. We were not able to identify a positive effect of adjuvan t irradiation in patients with negative lymph nodes and positive recep tor status: both patient groups with or without irradiation had simila r locoregional recurrence rates of 3%. In a subgroup of patients who w ere lymph node negative, receptor positive, and received adjuvant tamo xifen therapy, the local recurrence rates were as low as 2% in both gr oups. Concerning these results it may be possible to avoid the morbidi ty and potential psychological side effects of radiotherapy in breast cancer patients over 60 years of age treated by breast conserving surg ery (T1, N0, positive hormone receptor, adjuvant tamoxifen) without in creasing risk of locoregional recurrence. These data have to be confir med in a prospectively randomized fashion.