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The impact of tamoxifen on breast recurrence, cosmesis, complications, and survival in estrogen receptor positive early stage breast cancer

Abstract

Purpose: In the NSABP B14 trial evaluating tamoxifen (tam) in axillary node negative, estrogen receptor positive tumors fewer breast recurrences were observed in patients treated with conservative surgery and radiation who received tam compared to the observation arm. An additional series, however, has suggested that tam adversely impacts on the cosmetic result. To further address these issues we compared the outcome of estrogen receptor positive tumors treated with conservative surgery and radiation with or without tam. Materials and Methods: From 1982 to 1991, 491 women with estrogen receptor positive stage I-II breast cancer underwent excisional biopsy, axillary dissection and radiation. The median age of the patient population was 60 years (range 39-85). The median followup was 5.3 years (range .1-12.8). 69% had T1 tumors and 83% had histologically negative axillary nodes. Reexcision was performed in 49%. The final margin of resection was negative in 64%, unknown in 18%, and close or positive in 19%. None of the patients received adjuvant chemotherapy. 154 patients received tam and 337 received no adjuvant therapy. Patients who received tam were more often axillary node positive (44% tam vs 5% no tam) and less often had unknown margins (9% tam vs 22% no tam). There  More>>
Publication Date:
Jul 01, 1995
Product Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 32; Journal Issue: 971; Other Information: Copyright (c) 1995 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA); PBD: 1995
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ESTROGENS; MAMMARY GLANDS; NEOPLASMS; RADIOTHERAPY; SURGERY; SURVIVAL CURVES; TAMOXIFEN
OSTI ID:
20391363
Country of Origin:
United States
Language:
English
Other Identifying Numbers:
Journal ID: ISSN 0360-3016; IOBPD3; TRN: US03R1774059410
Submitting Site:
INIS
Size:
page(s) 150
Announcement Date:
Nov 20, 2003

Citation Formats

Fowble, B, Fein, D A, Hanlon, A L, Eisenberg, B L, Hoffman, J P, Sigurdson, E R, Daly, M B, and Goldstein, L J. The impact of tamoxifen on breast recurrence, cosmesis, complications, and survival in estrogen receptor positive early stage breast cancer. United States: N. p., 1995. Web. doi:10.1016/0360-3016(95)97683-R.
Fowble, B, Fein, D A, Hanlon, A L, Eisenberg, B L, Hoffman, J P, Sigurdson, E R, Daly, M B, & Goldstein, L J. The impact of tamoxifen on breast recurrence, cosmesis, complications, and survival in estrogen receptor positive early stage breast cancer. United States. doi:10.1016/0360-3016(95)97683-R.
Fowble, B, Fein, D A, Hanlon, A L, Eisenberg, B L, Hoffman, J P, Sigurdson, E R, Daly, M B, and Goldstein, L J. 1995. "The impact of tamoxifen on breast recurrence, cosmesis, complications, and survival in estrogen receptor positive early stage breast cancer." United States. doi:10.1016/0360-3016(95)97683-R. https://www.osti.gov/servlets/purl/10.1016/0360-3016(95)97683-R.
@misc{etde_20391363,
title = {The impact of tamoxifen on breast recurrence, cosmesis, complications, and survival in estrogen receptor positive early stage breast cancer}
author = {Fowble, B, Fein, D A, Hanlon, A L, Eisenberg, B L, Hoffman, J P, Sigurdson, E R, Daly, M B, and Goldstein, L J}
abstractNote = {Purpose: In the NSABP B14 trial evaluating tamoxifen (tam) in axillary node negative, estrogen receptor positive tumors fewer breast recurrences were observed in patients treated with conservative surgery and radiation who received tam compared to the observation arm. An additional series, however, has suggested that tam adversely impacts on the cosmetic result. To further address these issues we compared the outcome of estrogen receptor positive tumors treated with conservative surgery and radiation with or without tam. Materials and Methods: From 1982 to 1991, 491 women with estrogen receptor positive stage I-II breast cancer underwent excisional biopsy, axillary dissection and radiation. The median age of the patient population was 60 years (range 39-85). The median followup was 5.3 years (range .1-12.8). 69% had T1 tumors and 83% had histologically negative axillary nodes. Reexcision was performed in 49%. The final margin of resection was negative in 64%, unknown in 18%, and close or positive in 19%. None of the patients received adjuvant chemotherapy. 154 patients received tam and 337 received no adjuvant therapy. Patients who received tam were more often axillary node positive (44% tam vs 5% no tam) and less often had unknown margins (9% tam vs 22% no tam). There were no significant differences for the 2 groups for median age, primary tumor size, histology, race, or use of reexcision. Results: The 5 yr act rate of breast recurrence was 4% for the tam patients compared to 7% for patients not receiving tam (p=.21). At 8 yrs, the breast recurrence rates were 4% for the tam patients compared to 11% for the no tam patients (p=.05). However, at 9 years the rates were 17% tam vs 14% no tam (p=.21). The benefit from tam in terms of a decreased 5 year actuarial breast recurrence rate was most evident for patients who did not have a reexcision (3% tam vs 10% no tam, p=.15), had unknown margins (7% tam vs 13% no tam, p=.37) or close margins (0% tam vs 11% no tam, p=.34) and positive axillary nodes (4% tam vs 21% no tam, p=.08). For patients with negative axillary nodes the 5 yr act breast recurrence rates were 6% tam vs 7% no tam (p=.29). Tamoxifen did not result in a decreased 5 year act. breast recurrence rate in patients who had a reexcision (5% tam vs 3% no tam, p=.91), or women {<=}50 years of age (17% tam vs 13% no tam, p=.59). The 5 year act. cause-specific survival was 89% with tam and 94% without tam for the axillary node negative patients (p=.29). For the axillary node positive patients, the 5 year act. cause-specific survival was 90% with tam compared to 70% without tam. Cosmesis (physician assessment) was good-excellent in 85% of the tam patients compared to 88% of the no tam patients. For patients receiving radiation to the breast only, cosmesis was good-excellent in 84% of the tam patients and 87% of the no tam patients. For patients receiving treatment to the breast and regional nodes, 86% of the tam patients had a good to excellent cosmetic result compared to 92% of the no tam patients. Breast edema was more common in the patients receiving tam (49% tam vs 31% no tam). There was a slight increase in the incidence of breast cellulitis in the patients receiving tam (3% tam vs 1% no tam). Tamoxifen did not increase the incidence of arm edema, rib fracture, or symptomatic pneumonitis. Conclusion: Overall, tamoxifen results in a decreased risk of breast recurrence at 5 and 8 years, however, the benefit was no longer observed at 9 years. This finding suggests that tam may delay rather than prevent a breast recurrence in patients undergoing conservative surgery and radiation. Patients who appeared to benefit most in terms of a diminished risk of breast recurrence at 5 yrs from the addition of tam were those with no reexcision, unknown or close margins and positive axillary nodes. There was no decrease in breast recurrence with tam for patients {<=}50 years of age or those who had a reexcision. There was an improvement in cause-specific survival for axillary node positive patients with tam. There was no significant survival benefit with tam for node negative patients in this retrospective series. Tam had little adverse effect on cosmesis except for patients receiving treatment to the breast and regional nodes. Tam did not increase the risk of complications, i.e., pneumonitis, rib fracture, arm edema, however, breast edema and cellulitis were more common in patients receiving tam.}
doi = {10.1016/0360-3016(95)97683-R}
journal = {International Journal of Radiation Oncology, Biology and Physics}
issue = {971}
volume = {32}
journal type = {AC}
place = {United States}
year = {1995}
month = {Jul}
}