Breast conservation therapy as a treatment option for the elderly - The M.D. Anderson experience

BACKGROUND. Although almost half of all incidents of breast carcinoma occur in women age greater than or equal to 65 years, not enough is known about appropriate care for patients in this age group. The objective of the curre nt study was to evaluate the role of breast conservation therapy in the man agement of breast carcinoma in women age greater than or equal to 65 years. METHODS. From 1970 to 1994, 1325 patients with carcinoma of the breast were treated with breast conservation therapy (segmental mastectomy and radiati on therapy with or without axillary lymph node dissection) at The Universit y of Texas M. D. Anderson Cancer Center. From this patient group, the autho rs identified 184 elderly women (a 65 years) with Stage 0-III disease at th e time of diagnosis. RESULTS. The median patient age was 70 years (range, 65-88 years). The dist ribution of disease by stage among the women was Stage 0 disease in 12 pati ents (7%), Stage I disease in 107 patients (58%), Stage II disease in 63 pa tients (34%), and Stage III disease in 2 patients (1%). Comorbid conditions that may have influenced treatment planning were reported in 91 patients ( 50%). An axillary lymph node dissection was performed in 135 patients (73%) , with positive axillary lymph nodes found in 30 patients (22%). Adjuvant c hemotherapy was given to 10 patients (5%), and tamoxifen therapy was given to 63 patients (34%). Complications from treatment were reported in 24 pati ents (13%). With a median follow-up of 7.3 years (range, 0.25-23.5 years), 9 patients developed locoregional disease recurrence (5%), 10 patients deve loped contralateral breast carcinoma (5%), and 21 patients developed distan t metastasis (11%). At last follow-up, 113 patients (61 %) were alive, 15 p atients (8%) were dead of disease, and 56 patients (30%) were dead of other causes. The 5-year and 10-year disease specific survival rates were 96% an d 91%, respectively. CONCLUSIONS. Breast conservation therapy with segmental mastectomy and post operative radiation therapy with or without axillary lymph node dissection provides excellent local control and disease free survival in elderly women with breast carcinoma. This treatment should be considered as the standard of care for elderly patients without severe comorbid disease. (C) 2001 Ame rican Cancer Society.