Combined modality treatment of locally advanced breast carcinoma in elderly patients or patients with severe comorbid conditions using tamoxifen as the primary therapy

BACKGROUND. The purpose of the current study was to evaluate the objective response rate and possibility of breast-conserving surgery using neoadjuvan t tamoxifen in the multimodality treatment, including surgery and radiother apy, of elderly or frail patients with locally advanced breast carcinoma. METHODS, Forty-seven patients age > 75 years or age < 75 years with comorbi d conditions and locally advanced breast carcinoma were treated with neoadj uvant tamoxifen (20 mg/day) for 3-6 months. This was followed by surgery an d radiotherapy when feasible and adjuvant tamoxifen for 5 years or until di sease recurrence. RESULTS. The median age of the patients was 72 years (range, 48-86 years). Approximately 22% had T3 lesions, 57% had T4 lesions, 22% were Stage II (AJ CC Manual for Staging Cancer, 3rd edition), and 78% were Stage III. Eighty percent were estrogen receptor positive. After 6 months of treatment with n eoadjuvant tamoxifen, a response rate of 47% was observed, including a comp lete response rate of 6%. Twenty-nine patients (62%) were rendered free of disease by surgery, including 5 with breast-conserving procedures. After a median follow-up of 40 months, 23 patients (49%) remained disease free. The median survival time had not been reached at the time of last follow-up. N o major toxicity was observed, with the exception of one patient who develo ped a possible tamoxifen-related Stage I endometrial carcinoma. The estimat ed 2-year and 5-year progression free and overall survival rates were 50% a nd 41%, and 83% and 59%, respectively. CONCLUSIONS. The results of the current study show that neoadjuvant tamoxif en was effective in the treatment of elderly or frail patients with locally advanced breast carcinoma with estrogen receptor positive tumors, and resu lted in a reasonable response rate, including complete responses and good o verall survival. (C) 2000 American Cancer Society.