The Pharmaceutical Journal
Vol 273 No 7317 p373
18 September 2004

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Adjunct radiotherapy treatment challenged

A five-year study of women aged 50 and over, who had undergone surgery for early breast cancer, shows a substantially lower rate of local relapse with local radiotherapy plus tamoxifen compared with tamoxifen alone. However, overall survival at five years did not differ significantly between the groups (New England Journal of Medicine 2004;351:963-70). The authors of this study question the trend towards the use of adjuvant treatment with tamoxifen alone in such women.

A study of older women, aged 70 and over, who had undergone lumpectomy for early breast cancer, also compared treatment with tamoxifen alone or with local irradiation. The only significant difference between the two groups in this trial was in the rate of local or regional recurrence at five years (1 per cent with both treatments versus 4 per cent with tamoxifen alone). There were no differences in rates of mastectomy, distant metastases or five-year overall survival.

The investigators now believe that, for women aged 70 and over with early, oestrogen-receptor-positive breast cancer, lumpectomy plus adjuvant tamoxifen is a realistic choice (ibid, 971–7).

Another trial showed that, at 15 years, tamoxifen showed significantly better outcomes than placebo after lumpectomy. The hazard ratio for recurrence-free survival was 0.58. A further 12-year follow up showed greater benefit with cyclophosphamide, methotrexate, fluorouracil and tamoxifen than with tamoxifen alone (hazard ratio for recurrence-free survival 0.52 (Lancet 2004;364:68).