Once weekly irradiation in breast cancer

Eighty-four elderly patients with carcinoma of the breast were treated with a once-weekly schedule using 650 cGy per fraction to a total of six fractions. According to the TNM classification there were 8 patients with Stage I, 29 patients with Stage II, 45 patients with Stage III, and 2 patients with Stage IV disease. Primary surgical treatment included biopsy, that is, truecut needle biopsy or open biopsy in 53 patients and excision biopsy in 13 patients; the remaining 18 patients had mastectomy. The average age of patients was 69.2 years with the oldest 91 years of age. Ten patients died of concomitant causes during the follow-up period at an average age of 84.5 years. Patients included in this report had at least a 36 month follow-up period with the longest being 94 months. Acute reactions were noticeably less than those with daily treatment. Only one of the 36 patients, where the breast was preserved, had severe delayed skin reaction. Of the 37 patients with Stage I and II, 24 were alive and disease-free at the time of reporting. Three died of concomitant causes, 2 are alive with disease, and the remaining 8 patients died of recurrent of progressive disease. There were 45 patients with Stage IIIA and IIIB and in this group 11 are alive and disease-free, 7 died of concomitant causes, 12 died of progressive breast cancer, and the remaining 4 patients are alive with disease. The two remaining Stage IV patients died of their disease. Once-weekly treatment was well tolerated by all patients and the early local control result is encouraging. We are continuing to assess this type of fractionation in selected elderly patients, especially in those who live away from our center.