A brief overview of findings from NSABP trials of adjuvant therapy

A randomized trial of chemotherapy (L-PAM vs CMF) and irradiation for node positive breast cancer. Eleven year follow-up of a Piedmont Oncology Association trial

158 evaluable patients with stage II, lymph node positive, carcinoma of the breast were randomized to adjuvant therapy with either melphalan (L-PAM) or cyclophosphamide, methotrexate, and fluorouracil (CMF) after mastectomy. In addition, patients were randomized to be treated with or without post-operative irradiation therapy (RT) in addition to their chemotherapy. At a median follow-up time of 11 years, there is no difference in time to relapse (P = 0.69) or survival (P = 0.55) among the four treatment groups. Multivariate analysis including treatment arm, age, race, tumor size, histologic type, performance status, time to onset of treatment, menopausal status, and number of positive nodes, revealed that only the number of positive nodes (less than 4 vs greater than or equal to 4) was related to disease-free and overall survival. Ten year relapse-free survival for patients with less than 4 positive nodes compared to those with greater than or equal to 4 positive nodes was 63% versus 30%, and overall survival 63% versus 41%, respectively. Patients who received post-operative radiation therapy had significantly less local recurrence than those treated with chemotherapy alone (P = 0.03) but without improvement in relapse-free or overall survival. In this trial, post-operative radiation therapy when added to chemotherapy decreased the risk of local recurrence without adverse effects on survival. Treatment outcome was not influenced by chemotherapy regimen, but differences may have been obscured by the small sample size.

Breast cancer in the elderly. Current patterns of care

To evaluate age-related differences in the current patterns of presentation and clinical management of breast cancer patients, the authors reviewed 1795 patients referred to a university hospital for their initial treatment. No age-related differences were found with respect to laterality and anatomic site. Age-related differences were seen with respect to histology, with mucinous (colloid) carcinoma being relatively more common with increasing age and medullary and inflammatory carcinoma being more common among young patients. Patients over age 55 presented with more advanced extent of disease, but the proportion did not further increase above age 65. Patients age 75 and older were nearly twice as likely to have surgery as their sole treatment as patients under age 45. The difference in treatment was specifically associated with the differential use of adjuvant chemotherapy between age groups. Sixty percent of patients under 45 with regional node involvement received adjuvant chemotherapy compared with only 27% of those 65 and older. Despite their similar characteristics in regard to laterality, anatomic site, and histology, elderly patients are less frequently given adjuvant chemotherapy in stage II breast cancer.