Surgery With or Without Lymph Node Removal in Treating Older Women With Stage I or Stage IIA Breast Cancer

ETOP IBCSG Partners Foundation473 enrolled

Overview

RATIONALE: Removing axillary lymph nodes may be effective in stopping the spread of breast cancer cells. It is not yet known if surgery to remove breast cancer is more effective with or without lymph node removal. PURPOSE: Randomized phase III trial to compare the effectiveness of breast surgery with or without removal of axillary lymph nodes in treating women who have stage I or stage IIA breast cancer.

OBJECTIVES: * Compare local and systemic disease-free survival, ipsilateral axillary relapse, occurrence of postmastectomy syndrome, and overall survival of elderly women with clinically operable stage I or IIA breast cancer who subsequently receive adjuvant tamoxifen after treatment with breast surgery with or without axillary node dissection. * Compare the toxicity of these regimens in these patients. * Compare the quality of life in patients treated with these regimens. OUTLINE: This is a randomized, multicenter study. Patients are stratified according to whether they received prior primary surgery (yes vs no) and participating center. * Arm I: Patients undergo mastectomy, lumpectomy, or quadrantectomy with axillary clearance. Patients then receive oral tamoxifen for 5 years. Patients may also undergo sentinel node biopsy. * Arm II: Patients undergo surgery as in arm I without axillary clearance. Patients then receive oral tamoxifen for 5 years. Patients in both arms who undergo breast-conserving surgery may receive optional radiotherapy for 5-6 weeks to the remaining breast tissue, chest, and lung. Upon recurrence in the conserved breast, patients undergo total mastectomy; those in arm II who experience ipsilateral axillary recurrence undergo surgical excision. Adjuvant tamoxifen and follow up are continued. Quality of life is assessed. Patients are followed every 3 months for 1 year, every 6 months while receiving tamoxifen, and then annually thereafter. PROJECTED ACCRUAL: A total of 1,020 patients will be accrued for this study within approximately 5 years.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

473

Conditions

Breast Cancer

Interventions

tamoxifen citrateDRUG

20 mg daily beginning within 6 weeks of surgery for 5 years or until relapse, whichever occurs first.

conventional surgeryPROCEDURE

Either total mastectomy or, optionally if the tumor was smaller than 5 cm, a breast conserving procedure (lumpectomy or quadrantectomy).

radiation therapyRADIATION

No radiotherapy is to be given after mastectomy. Radiotherapy is optional after breast conserving surgery according to prospectively determined guidelines within each institution. It should be given to the breast only and not to the draining node areas.

Eligibility

Sex: FEMALEMin age: 60 Years

Medical Language ↔ Plain English

DISEASE CHARACTERISTICS: * Histologically or cytologically confirmed stage I or IIA breast carcinoma that is considered operable * No prior axillary clearance or biopsy * Complete excisional biopsy of primary tumor without axillary clearance or biopsy allowed * Suspicious manifestations of metastatic disease (e.g., hot spots on bone scan or skeletal pain of unknown cause) must be proven benign * No bilateral breast cancer (any mass in contralateral breast must be proven benign by biopsy) * Hormone receptor status: * Not specified PATIENT CHARACTERISTICS: Age: * 60 and over Sex: * Female Menopausal status * Postmenopausal Performance status: * Not specified Hematopoietic: * WBC greater than 4,000/mm\^3 * Platelet count greater than 100,000/mm\^3 Hepatic: * Bilirubin less than 1.1 mg/dL * AST less than 60 U/L Renal: * Creatinine less than 1.3 mg/dL Cardiovascular: * Normal cardiac function * No history of congestive heart failure Other: * No nonmalignant systemic disease that would preclude protocol therapy or prolonged follow-up * No psychiatric or addictive disorder that would preclude protocol therapy or informed consent * No other prior or concurrent malignancy except nonmelanomatous skin cancer or adequately treated carcinoma in situ of the cervix * Geographically accessible for follow-up PRIOR CONCURRENT THERAPY: Biologic therapy: * No prior biologic therapy for breast cancer Chemotherapy: * No prior chemotherapy for breast cancer Endocrine therapy: * No prior endocrine therapy for breast cancer Radiotherapy: * No prior radiotherapy for breast cancer Surgery: * See Disease Characteristics

Locations (21)

Royal Prince Alfred Hospital, Sydney

Sydney, New South Wales, Australia

Newcastle Mater Misericordiae Hospital

Waratah, New South Wales, Australia

Outcomes

Primary Outcomes

Disease-free survival

Time from randomization to recurrence, metastasis, appearance of a second primary tumor, or death from any cause, whichever occurs first.

Time frame: 17 years from randomization

Secondary Outcomes

Overall survival

Time from randomization to death.

Time frame: 17 years from randomization

Toxicity

Side effects of treatment, especially surgery-related events.

Time frame: 17 years from randomization

Quality of life

Quality of life will be assessed by standard International Breast Cancer Study Group instruments

Time frame: 17 years from randomization

Data from ClinicalTrials.gov

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