Passage K J, McCarthy N J
Department of Medical Oncology, Westmead Hospital, Sydney, New South Wales, Australia.
Intern Med J. 2007 Mar;37(3):181-9. doi: 10.1111/j.1445-5994.2007.01269.x.
The treatment of elderly women (> or =70 years) with early-stage breast cancer is an emerging clinical problem in the setting of an ageing population. There is a lack of clinical trial evidence to formulate clinical guidelines for management because of the small number of elderly women included in previous clinical trials of adjuvant therapy. This often results in elderly patients being denied standard management based on age alone. The often-complex interaction between age, comorbid conditions and function complicate the planning and outcomes of surgery and can have an effect on the delivery of postoperative adjuvant therapy. A comprehensive assessment of the elderly patient is essential to determine overall prognosis and morbidity risk from treatments; however, a simple comorbidity scale for use in routine clinical practice remains elusive. Thus, treatment decisions should be tailored to the individual to ensure that therapies are not unduly withheld and are appropriate for the patient's overall condition. The assessment of the elderly patient with breast cancer requires the involvement of a multidisciplinary team. The evidence for efficacy, safety and potential risks of surgery and adjuvant therapies (including radiotherapy, hormone therapy and chemotherapy) in the elderly population is discussed in this review and the role of comprehensive geriatric assessment is outlined.
在人口老龄化背景下，老年女性（≥70岁）早期乳腺癌的治疗是一个新出现的临床问题。由于既往辅助治疗临床试验纳入的老年女性数量较少，缺乏制定临床管理指南的临床试验证据。这常常导致老年患者仅因年龄就被拒绝接受标准治疗。年龄、合并症和功能之间复杂的相互作用使手术规划和结果变得复杂，并可能影响术后辅助治疗的实施。对老年患者进行全面评估对于确定治疗的总体预后和发病风险至关重要；然而，用于常规临床实践的简单合并症量表仍然难以找到。因此，治疗决策应因人而异，以确保不过度拒绝治疗且治疗适合患者的整体状况。对老年乳腺癌患者的评估需要多学科团队的参与。本文综述了手术及辅助治疗（包括放疗、激素治疗和化疗）在老年人群中的疗效、安全性及潜在风险的证据，并概述了综合老年评估的作用。
