Muss Hyman B, Biganzoli Laura, Sargent Daniel J, Aapro Matti
University of Vermont and Vermont Cancer Center, Burlington, VT 05401, USA.
J Clin Oncol. 2007 May 10;25(14):1870-5. doi: 10.1200/JCO.2006.10.3457.
Adjuvant chemotherapy has led to improvements in relapse-free and overall survival in patients with breast, colon, and non-small-cell lung cancer, yet many older patients are not offered these potentially life-saving treatments. Moreover, older patients have been either excluded or under-represented in most adjuvant trials, limiting the generalizability of these treatments to older populations. Limited data in elders suggest that older patients derive significant benefits from adjuvant therapies provided they have life expectancies exceeding 5 years. Making treatment decisions in elders is challenging. Many have major comorbidities that may substantially limit life expectancy and minimize or negate the benefits of adjuvant chemotherapy. In this review, we discuss the potential benefits of adjuvant treatment in older patients with solid tumors with a focus on general principles involved in the selection of adjuvant therapy for patients with breast, colon, and non-small-cell lung cancer. In addition, we discuss the role of comorbidity and how it factors in treatment decisions. Finally, we discuss future research directions and funding for elders with cancer.
辅助化疗已使乳腺癌、结肠癌和非小细胞肺癌患者的无复发生存期和总生存期得到改善，但许多老年患者并未接受这些可能挽救生命的治疗。此外，在大多数辅助治疗试验中，老年患者要么被排除在外，要么所占比例过低，这限制了这些治疗方法在老年人群中的推广应用。针对老年人的有限数据表明，只要预期寿命超过5年，老年患者就能从辅助治疗中获得显著益处。在老年人中做出治疗决策具有挑战性。许多老年患者患有严重的合并症，这可能会大幅缩短预期寿命，并使辅助化疗的益处最小化或化为乌有。在本综述中，我们讨论了老年实体瘤患者辅助治疗的潜在益处，重点关注乳腺癌、结肠癌和非小细胞肺癌患者辅助治疗选择所涉及的一般原则。此外，我们还讨论了合并症的作用及其在治疗决策中的影响因素。最后，我们讨论了老年癌症患者未来的研究方向和资金问题。
