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In breast carcinoma

Despite some side effects, it has been clearly demonstrated that tamoxifen prescribed as an adjuvant treatment offers major benefit for patients with positive oestrogen receptors, independently of age.

This was clearly demonstrated by meta-analysis carried out it 1988 which revealed patient benefit independently of node status. The decreased risk of relapse was more significant during the first 5 years than during the following 5 years. However, a decrease in death rate was also systematically observed.

Consensus conferences by the NIH recommend the prescription of antioestrogens for all women with positive receptors, without taking into account tumour size or node status.

There is also a ±50% decrease in the risk of second breast cancer (controlateral) during the first five years, even when the tumour does not bear receptors.

The prolonged and systematic prescription of tamoxifen is limited by the increased risk of corpus uteri cancer (despite the fact that it is very often a minor and surgically curable cancer).

In the future, antiaromatase drugs may have an equivalent role in this adjuvant setting (but at a much higher cost), but our experience is, as yet, insufficient for us to be totally certain of this role. We are unaware of the exact incidence and gravity of potentially induced osteoporosis.

Ovarian suppression (for non-menopaused women), in an adjuvant setting, would also appear to be beneficial (reduction in relapse of 13%) and a probable increase in survival Although most meta-analyses have been developed with surgical or radiotherapic castration, it seems logical that ovarian suppression induced by LHRH agonists will offer the same benefits. These drugs have the advantage of enabling non-definitive castration, which is a very important point for young women who may desire pregnancy at distance from their cancer treatment.

In prostate carcinoma

Adjuvant therapy does not appear to bring any benefits in localised disease either before or after radical prostatectomy. Such treatment does not reduce the number of positive margins and does not increase disease-free survival.

In locally advanced disease (T3 with elevated Gleason histological grade or high levels of PSA), Bolla demonstrated a clear advantage in the simultaneous association of radiotherapy and hormonotherapy which should be prescribed for at least 3 years. There is no data for smaller stages.

For these patients, hormonotherapy carries an impotence risk close to 100%, whereas sexual potency (possibly with the help of Viagra) may resist radiotherapy.