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Author Notes:

Kevin S. Hughes, MD, FACS, Surgical Director, Breast Screening, Co-Director, Avon Comprehensive Breast Evaluation Center, Massachusetts General Hospital, Associate Professor of Surgery, Harvard Medical School, 55 Fruit St, Yawkey 7, Boston, MA 02114; e-mail: kshughes@partners.org.

Conception and design: Kevin S. Hughes, Lauren A. Schnaper, Constance T. Cirrincione, Donald A. Berry, Hyman B. Muss, William C. Wood; Administrative support: Kevin S. Hughes, Constance T. Cirrincione, Beryl McCormick, Hyman B. Muss, Clifford A. Hudis, Eric P. Winer, William C. Wood; Provision of study materials or patients: Kevin S. Hughes, Beryl McCormick, Hyman B. Muss, Barbara L. Smith, Clifford A. Hudis, Eric P. Winer, William C. Wood; Collection and assembly of data: Kevin S. Hughes, Constance T. Cirrincione, Donald A. Berry, Beryl McCormick; Data analysis and interpretation: All authors; Manuscript writing: All authors; Final approval of manuscript: All authors.

The author(s) indicated no potential conflicts of interest.



  • Science & Technology
  • Life Sciences & Biomedicine
  • Oncology

Lumpectomy Plus Tamoxifen With or Without Irradiation in Women Age 70 Years or Older With Early Breast Cancer: Long-Term Follow-Up of CALGB 9343

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Journal Title:

Journal of Clinical Oncology


Volume 31, Number 19


, Pages 2382-+

Type of Work:

Article | Final Publisher PDF


Purpose: To determine whether there is a benefit to adjuvant radiation therapy after breast-conserving surgery and tamoxifen in women age ≥ 70 years with early-stage breast cancer. Patients and Methods: Between July 1994 and February 1999, 636 women (age ≥ 70 years) who had clinical stage I (T1N0M0 according to TNM classification) estrogen receptor (ER) –positive breast carcinoma treated by lumpectomy were randomly assigned to receive tamoxifen plus radiation therapy (TamRT; 317 women) or tamoxifen alone (Tam; 319 women). Primary end points were time to local or regional recurrence, frequency of mastectomy, breast cancer–specific survival, time to distant metastasis, and overall survival (OS). Results: Median follow-up for treated patients is now 12.6 years. At 10 years, 98% of patients receiving TamRT (95% CI, 96% to 99%) compared with 90% of those receiving Tam (95% CI, 85% to 93%) were free from local and regional recurrences. There were no significant differences in time to mastectomy, time to distant metastasis, breast cancer–specific survival, or OS between the two groups. Ten-year OS was 67% (95% CI, 62% to 72%) and 66% (95% CI, 61% to 71%) in the TamRT and Tam groups, respectively. Conclusion: With long-term follow-up, the previously observed small improvement in locoregional recurrence with the addition of radiation therapy remains. However, this does not translate into an advantage in OS, distant disease-free survival, or breast preservation. Depending on the value placed on local recurrence, Tam remains a reasonable option for women age ≥ 70 years with ER-positive early-stage breast cancer.

Copyright information:

© 2013 by American Society of Clinical Oncology.

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