Neo adjuvant Tamoxifen in post menopausal patients with operable breast cancer R. J. Salmon, Y. Remvikos, F. Campana, O. Languille, H. Magdalenat, B. Asselain, K. B. Clough and The Breast Group of the Institut Curie The Breast Group, Institut Curie, 26 rue d’Ulm, 75005 Paris, France Aims: Tamoxifen is widely used as adjuvant therapy in receptor positive post menopausal breast cancer. Little is known about its efficacy as neo adjuvant therapy in terms of breast conservation and improved survival. Methods: We analyzed the tumour response to 20–30 mg Tamoxifen for 6 months in post menopausal patients with oestrogen receptor positive tumours. Treatment included Tamoxifen for 6 months, surgical resection, and irradiation for post menopausal patients refusing initial mastectomy; aged $ 70 years; or with other factors delaying surgery. Results: Between April 1994 and June 1998, 102 patients, age 73 ^ 87 (54–90) were studied. There were 24 T1, 56 T2, 14 T3, and 8 T4 tumours. Clinical response to Tamoxifen was observed in all patients, with a median size reduction from 31 ^ 15 (9–70) to 16 ^ 9 mm (0 – 50), 15 clinical and 6 complete responses. 88/102 patients were treated conservatively. Radiotherapy was given to 80 and a flash technique to 8 patients. All patients but one are still alive. Conclusion: Neo adjuvant Tamoxifen in operable post menopausal ER positive breast cancer is associated with a good clinical response rate and facilitates conservative surgery. Tamoxifen has a valuable role as neo-adjuvant treatment in terms of breast conservation and survival. q 2003 Elsevier Ltd. All rights reserved. INTRODUCTION The incidence of breast cancer in elderly women is increasing in Western countries. One-quarter of cases of breast cancer affect women over the age of 70 years, and 10% of breast cancers are diagnosed in women over the age of 80 years. The management of these cancers in elderly patients remains controversial due to the risk of under-treatment with a risk of subsequent recurrence in an even older woman; and comorbidity, which can interface with conventional therapeutic strategies. Some authors have supported mastectomy alone, while others promote treatment with irradiation or Tamoxifen alone. 1–4 Three randomized studies failed to show a survival benefit in favour of either strategy. 5–7 Most authors consider hormone receptor status to be the major criterion for administration of Tamoxifen, but the published results concerning the response to neo adjuvant Tamoxifen are discordant, with response rates varying from 30 to 60%. 7–14 These differences are related to very variable durations of neo adjuvant Tamoxifen treatment. Therapeutic escape may occur in responding tumours 15–17 after 12–18 months of Tamoxifen administration alone, aromatases inhibitors also have a role as neo-adjuvant therapy in RH þ cancers. 18 – 23 We take a pragmatic attitude to patients over 70 years, using either exclusive radiation-therapy, or mas- tectomy with Tamoxifen. 15 In this paper, we report a study of patients over the age of 70 years with oestrogen receptor positive tumours: undergoing neo-adjuvant treatment with Tamoxifen, for a period of 6 months, followed by a surgical procedure, and by a postoperative irradiation. PATIENTS AND METHODS From April 1994 to June 1998, we studied 102 patients mean age 73 ^ 8.7 years (range: 57–90) with informed oral consent. There were 98 unifocal and 4 multifocal cancers. Mean initial size was 31 ^ 15 (9–70) mm. There were 24 T1, 56 T2, 14 T3, 8 T4 and 84 N0, 16 N1, 3 N2 tumours. Mammography and breast ultrasound were performed in all patients. A cytological n ¼ 88 and/or histological n ¼ 37 diagnosis was obtained in all patients, before any treatment. There were 90 invasive ductal and 12 lobular 0748–7983/03/$30.00 q 2003 Elsevier Ltd. All rights reserved. EJSO 2003; 29: 831–834 doi:10.1016/S0748-7983(03)00095-7 Correspondence to: The Breast Group, Institut Curie, 26 rue d’Ulm, 75005 Paris, France. Tel.: þ1-44-32-46-50; Fax: þ 1-44-32-46-23