Basso Umberto, Brunello Antonella, Pogliani Claudia, Monfardini Silvio
Department of Medical Oncology, Ospedale Busonera, via Gattamelata 64, Azienda Ospedale - Università, 35100 Padova, Italy.
Expert Rev Anticancer Ther. 2004 Apr;4(2):197-211. doi: 10.1586/14737140.4.2.197.
In clinical practice, approximately 50% of new cases of breast cancer occur in women over the age of 65 years, although very few elderly women have been enrolled in the numerous randomized trials conducted so far. Notwithstanding less aggressive biologic features compared with younger patients, breast cancer impacts on mortality of elderly women, especially if not adequately treated. As confirmed by meta-analyses, hormonal therapy is the most effective adjuvant measure for patients with localized disease, whereas the decrease in the benefit of cytotoxic treatment with increased risk of toxicity make the decision on when and how to administer it a major challenge for the medical oncologist. Careful evaluation of biological prognostic factors, performance status and geriatric parameters, such as functional independence, comorbidities and cognitive function of the patient, along with determination of her life expectancy and preferences, represent the relevant information on which the oncologist should ground their decision for integrated treatment with conservative surgery, radiotherapy and hormonochemotherapy in otherwise healthy women, or attenuated or palliative measures for the frail patients, in order to maximize the balance of benefits and toxicities. The aims of this review are to summarize the most relevant concepts for decision making in the clinical practice and discuss the results of recent research concerning the additional needs of elderly women with early breast cancer.
在临床实践中，约50%的新发乳腺癌病例发生在65岁以上的女性中，尽管到目前为止进行的众多随机试验中纳入的老年女性很少。尽管与年轻患者相比，老年女性的生物学特征侵袭性较小，但乳腺癌仍会影响老年女性的死亡率，尤其是在治疗不充分的情况下。荟萃分析证实，激素治疗是局部疾病患者最有效的辅助治疗措施，而细胞毒性治疗的获益降低且毒性风险增加，使得决定何时以及如何进行这种治疗成为肿瘤内科医生面临的一项重大挑战。仔细评估生物学预后因素、体能状态和老年参数，如患者的功能独立性、合并症和认知功能，同时确定其预期寿命和偏好，这些是肿瘤内科医生在为健康女性制定综合治疗方案（包括保守手术、放疗和激素化疗），或为体弱患者制定减量化或姑息性措施时做出决策所需依据的相关信息，以便最大限度地平衡获益和毒性。本综述的目的是总结临床实践中决策的最相关概念，并讨论近期关于早期乳腺癌老年女性额外需求的研究结果。
