Table 3 Management of patients with breast cancer with lymph node involvement (N+ve)
Premenopaual woman or ⩽50 years old ( Figure 16 ) | Post menopausal woman or >50 years old ( Figure 17 ) | |||
|---|---|---|---|---|
ER+ve | ER−ve or unknown | ER+ve or unknown | ER−ve | |
Standards | Chemotherapy and tamoxifen | Chemotherapy, no hormone therapy | Tamoxifen | No standard |
Options | Chemotherapy and ovarian suppression ±tamoxifen | Tamoxifen and chemotherapy | Chemotherapy | |
Ovarian suppression ±tamoxifen (no chemotherapy) | No adjuvant treatment | |||
Recommendations | Tamoxifen as adjuvant treatment in premenopausal women can only be used in association with chemotherapy | Independent of the hormone receptor status of the tumour. High dose chemotherapy is not recommended except in the setting of a randomised clinical trial (expert agreement) | No chemotherapy if age and performance status suggest poor short-and/or long-term tolerance (level of evidence: B) | |
The efficacy of the combination of ovarian suppression and antioestrogens is unknown (level of evidence: D) This combination should be evaluated in randomised clinical trials (expert agreement) | ||||
