Adjuvant radiotherapy for breast carcinoma in men: a 20-year clinical experience

Breast cancer in men is a rare malignancy. Current knowledge about its natural history and diagnostic and therapeutic management relies on reviews and few retrospective studies. From 1972 to 1993, 21 men were irradiated for operable primary (n = 17) or recurrent (n = 4) breast cancers at our institution. The mean age at initial diagnosis was 60 years (45-79 years). Tumor distribution by stage was: stage I (two), stage II (seven), stage III (six), stage IV (two), and unknown in four cases. Patients received radiotherapy to the chest-wall and ipsilateral lymph nodes (17) and to the axilla (seven). Additionally hormones (two) and chemotherapy (four) were applied in some cases. Follow-up ranged from 24 to 190 months (median, 53 months). At last follow-up (November 1994), nine patients were alive and eight without disease. The median overall survival of the whole group was 69 months (mean, 106 months). The 3-year (70%), 5-year (59%) and 10-year survival rates (46%) were consistent with literature data. Overall, relapse- and disease-free survival rates were better in patients with stage I/II than in those with stage III/IV disease. Univariate analysis revealed more favorable results for patients with negative axillary nodes, patients younger than 60 years, those with centrally localized tumors, and patients with a diagnostic delay of < 3 months, but the differences were not statistically significant. Six patients relapsed who had not received initial adjuvant radiotherapy to the site of their relapse. At last follow-up, 13 patients had distant metastases, and 12 of them are dead of the metastatic disease, which developed less frequently in stage I/II than in stage III/IV disease. Postoperative adjuvant radiotherapy is an essential part of the overall treatment strategy of advanced node-negative and node-positive cancer of the breast in men.