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ASCO: Forgoing Radiation Safe in Older Breast Cancer Patients

No difference seen in 10-year survival with tamoxifen alone, tamoxifen plus radiation

FRIDAY, May 21 (HealthDay News) -- In older women with stage I, estrogen receptor-positive, node-negative breast cancer, those who undergo lumpectomy and receive tamoxifen may safely forgo radiation therapy, according to a study released May 20 in advance of the American Society of Clinical Oncology's 46th Annual Meeting, to be held June 4-8 in Chicago.

Kevin Hughes, M.D., of Massachusetts General Hospital in Boston, and colleagues randomly assigned 636 women aged 70 and older who underwent lumpectomy to receive either tamoxifen alone or tamoxifen and radiation. Previously, the researchers had demonstrated that tamoxifen alone was an effective alternative to tamoxifen and radiation after a median follow-up of 7.9 years. Their new analysis includes data after a median follow-up of 10.5 years.

Although the researchers found that the rate of breast cancer recurrence in the affected breast was higher in the tamoxifen-alone group than in the tamoxifen-radiation group (8 percent versus 2 percent), they found that there were no significant group differences in either breast cancer-specific survival (98 percent versus 96 percent) or overall survival (63 percent versus 61 percent).

"The standard of care for women 70 and older with very small tumors that are estrogen-positive and node-negative -- the largest group of breast cancer patients in this age group -- had been lumpectomy and radiation," Hughes said in a statement. "Earlier reports of this study with shorter median follow-up have shown the risk of recurrence without radiation to be only marginally worse than with radiation, but there was concern that longer follow-up would show a blossoming of recurrences. This study confirms that for older women with early-stage breast cancer, lumpectomy without radiation is a viable alternative, and tamoxifen may replace the need for radiation."

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