Kümmel Sherko, Elling Dirk, Jeschke Sophia, Schmid Peter, Thomas Anke
Departments of Senology, University Medicine Berlin, Charité Campus Mitte, Berlin, Germany.
Anticancer Res. 2006 Mar-Apr;26(2C):1673-6.
Due to improved life expectancy and the increase in incidence of breast cancer in old age, ever more older women are developing this disease. Although there is only limited evidence-based data from randomized trials on the treatment, older patients are still under-represented in clinical studies, and currently there is no clear consensus on chemotherapy treatment for older women with breast cancer. Adjuvant therapy strategies, in particular, suffer from a lack of uniform standards and reflect a generally less aggressive treatment. Recently published studies have shown that older women suffering from breast cancer can also profit from a treatment based on therapeutic standards and consensus guidelines. In spite of developments in adjuvant chemotherapy using increased amounts of therapeutic agent to improve survival, many older patients receive instead reduced quantities of chemotherapeutic agent. Thus, the questions arise, whether undertreatment of older patients with breast cancer can lead to a poorer outcome or whether new therapy strategies (e.g., dose-intensive chemotherapy) can be used with older patients. A common reason for dose reductions is neutropenia, but studies have shown that it is manageable by using granulocyte colony-stimulating factors (G-CSFs). In this review, the current status of clinical research in the area of adjuvant treatment and the necessity for clinical studies that take into account the special therapeutic requirements of older women are discussed.
由于预期寿命的提高以及老年乳腺癌发病率的上升，越来越多的老年女性患上了这种疾病。尽管关于治疗的随机试验仅有有限的循证数据，但老年患者在临床研究中的代表性仍然不足，目前对于老年乳腺癌女性的化疗治疗尚无明确的共识。尤其是辅助治疗策略缺乏统一标准，且总体上体现出治疗积极性较低。最近发表的研究表明，患乳腺癌的老年女性也能从基于治疗标准和共识指南的治疗中获益。尽管辅助化疗在使用更多治疗药物以提高生存率方面取得了进展，但许多老年患者接受的化疗药物剂量却减少了。因此，出现了这样的问题：对老年乳腺癌患者治疗不足是否会导致更差的预后，或者新的治疗策略（如剂量密集化疗）是否可用于老年患者。剂量减少的一个常见原因是中性粒细胞减少，但研究表明，使用粒细胞集落刺激因子（G-CSF）可对其进行控制。在本综述中，讨论了辅助治疗领域的临床研究现状以及开展考虑老年女性特殊治疗需求的临床研究的必要性。
