The effects of postradiation treatment with tamoxifen on local control and cosmetic outcome in the conservatively treated breast

• Published in: Cancer Vol. 80; no. 4; pp. 732 - 740
• Main Authors: Wazer, David E., Morr, Jody, Erban, John K., Schmid, Christopher H., Ruthazer, Robin, Schmidt‐Ullrich, Rupert K.
• Format: Journal Article
• Language: English
• Published: New York John Wiley & Sons, Inc 15.08.1997; Wiley-Liss
• Subjects: Adult; Aged; Aged, 80 and over; Antineoplastic Agents, Hormonal - adverse effects; Antineoplastic Agents, Hormonal - therapeutic use; Biological and medical sciences; Breast; breast conservation; Breast Neoplasms - drug therapy; Breast Neoplasms - radiotherapy; Breast Neoplasms - surgery; Combined Modality Therapy; cosmesis; Esthetics; Female; Gynecology. Andrology. Obstetrics; Humans; local control; Lymphatic Metastasis; Mammary gland diseases; Mastectomy, Segmental; Medical sciences; Middle Aged; Neoplasm Recurrence, Local; Neoplasm, Residual; radiotherapy; tamoxifen; Tamoxifen - adverse effects; Tamoxifen - therapeutic use; Treatment Outcome; Tumors; Cosmetic; Human; Postoperative; Carcinoma; Treatment efficiency; Malignant tumor; Radiotherapy; Survival; Tamoxifene; Mammary gland diseases; Conservative surgery; Treatment; Surgery; Mammary gland; Non steroid compound
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/(SICI)1097-0142(19970815)80:4<732::AID-CNCR12>3.0.CO;2-U

BACKGROUND The aim of this study was to evaluate the impact on disease recurrence and cosmetic outcome of tamoxifen treatment initiated after breast‐conserving therapy (BCT). METHODS Between 1982 and 1994, 498 women (509 breasts) were treated with BCT in accordance with a highly standardized institutional protocol. Adjuvant tamoxifen was administered to 130 patients (134 breasts), beginning 1‐6 weeks after irradiation. The median ages and duration of follow‐up for groups who received tamoxifen (TAM+) and no tamoxifen (TAM‐) were 62.5 years/56 months and 53 years/60 months, respectively. The members of the TAM+ group were significantly older (P = 0.0001) and had increased incidences of positive axillary lymph nodes or undissected axilla (P = 0.001). There was a significant (P = 0.001) difference between the TAM+ and TAM‐ groups in the distribution of histopathologic subtypes; this reflected an increased proportion of associated ductal carcinoma in situ in the TAM‐ group. More extensive regional lymphatic irradiation was administered to the TAM+ group. Chemotherapy was administered to 15% of TAM+ and 28% (P = 0.003) of TAM‐ patients. There were no significant differences between the groups with respect to tumor size, reexcision, total excised tissue volume, final margin status, total radiation dose, or use of interstitial implant boost. RESULTS There was no significant difference between the TAM+ and TAM‐ groups in the overall distribution of cosmetic scores (P = 0.18). The 5‐, 7‐, and 10‐year actuarial local failure rates for TAM+ versus TAM‐ patients were 0% versus 3.1%, 1.9% versus 5.4%, and 1.9% versus 8.4%, respectively. Multivariate regression analyses of potentially confounding variables revealed no significant associations between tamoxifen and either cosmetic outcome or local failure. CONCLUSIONS Radiotherapy followed by tamoxifen has no adverse interactive effect on cosmesis, and tamoxifen is associated with a trend toward enhanced 5‐year local control probability. Cancer 1997; 80:732‐40. © 1997 American Cancer Society. Tamoxifen administration initiated 1‐6 weeks postradiation does not compromise local control or cosmetic outcome in the conservatively treated breast. In fact, tamoxifen may confer a modest enhancement of local control.