Post-mastectomy radiotherapy is associated with a lower local relapse rate and an improved disease-free and overall survival when combined with chemotherapy in pre-menopausal high-risk breast cancer patients. However, it has been unclear whether the same benefits also apply to similar high-risk post-menopausal women treated with adjuvant tamoxifen. The Danish Breast Cancer Cooperative Group performed a randomized clinical trial to evaluate the effects of radiation therapy for prevention of relapses.

One thousand three hundred seventy-five post-menopausal women with stage II or III breast cancer were randomized to receive or not receive radiation therapy after surgery. All patients were treated with tamoxifen and the average follow-up is now 123 months.

Local cancer recurrences occurred in 8% of the women treated with tamoxifen and radiation compared to 35% of the women treated with tamoxifen alone. In total, 47% of patients receiving radiation developed recurrent cancer compared to 60% of patients not receiving radiation therapy. Survival, free of cancer, was 36% in the radiotherapy group and 24% in the tamoxifen only group. Overall survival was 45% for the radiation therapy group compared to 36% for the tamoxifen only group.

These physicians concluded that radiation therapy decreased the risk of local cancer recurrences and was associated with improved survival in high-risk post-menopausal breast cancer patients after surgical treatment with mastectomy and limited axillary lymph node dissection. This study points out the importance of both local therapy and systemic therapy for the prevention of relapses in patients with stage II-III breast cancer. (Lancet, Vol 353, No 9165, pp1641-48,1999)

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