Wide Excision without Radiation as Primary Treatment for Breast Cancer in Older Patients

ABSTRACT

Introduction: Prior to the introduction of sentinel lymph node sampling, wide excision and axillary dissection followed by radiation to the breast was considered a standard treatment for breast cancer. Not all patients who undergo breast conserving surgery receive radiation therapy, which is considered suboptimal care. We have evaluated our experience with wide excision alone and its effect on local-regional recurrence, development of metastatic disease and survival. Materials and Methods: Between 1987-1997 we identified 69 patients (70 breasts) treated with wide excision without radiation for their primary breast cancer. Results: The median age at diagnosis was 79 years. Median follow-up was 6.7 years. The median tumor size was 1.1 cm (range 0.2 - 3.5 cm). Fifty three percent of the patients received tamoxifen. Tumor size was significant for failure and survival. Seven (10%) patients failed. Only 6 patients (9%) had an ipsilateral recurrence requiring surgical intervention. Two of the six developed metastatic disease. One additional patient had distant spread without a detected local failure. Overall, 3 (4%) developed metastatic disease and died with breast cancer as a contributing factor. Sixty four percent of the patients died without contribution from the breast cancer, and 31% were alive without disease. Conclusions: Not all patients require radiation for cancer control after wide excision. Patients who can be considered for surgery alone without an unacceptable risk are the elderly (especially those with comorbid conditions with small low grade tumors treated with wide surgical margins).