未接受放疗的老年乳腺癌患者的成功管理。
Successful management of elderly breast cancer patients treated without radiotherapy.
作者信息
Valassiadou Kalliope, Morgan David A L, Robertson John F R, Pinder Sarah E, Cheung Kwok-Leung
机构信息
Division of Breast Surgery, University of Nottingham, Nottingham, UK.
出版信息
World J Surg Oncol. 2007 Jun 3;5:62. doi: 10.1186/1477-7819-5-62.
BACKGROUND
Breast cancer in the elderly may follow a less aggressive course. There are data suggesting that radiotherapy (RT) following breast conserving surgery (BCS) for invasive carcinoma may not be necessary in some elderly patients. The addition of RT to surgery might constitute an imposition to such patients due to age-related factors. The aim of this study was to assess the efficacy of BCS without adjuvant RT in this group of patients.
PATIENTS AND METHODS
A retrospective review of 92 elderly (median age 75 years; range: 70 - 87 years) patients (analysed as 93 'patients' due to one patient having bilateral cancers) managed in a dedicated breast clinic and who underwent BCS for invasive carcinoma was carried out. Eighty-three patients did not receive postoperative RT to the breast (no-RT group) whereas the remaining 10 had RT (RT-group).
RESULTS
The median age in this group was 75 (range 70 - 87) years. The mean tumour size was 18 mm with a median follow-up of 37 (range 6 - 142) months. In the no RT group, adjuvant endocrine therapy with tamoxifen was given to 40/53 patients. No patients in the oestrogen receptor (ER) negative group received tamoxifen. The local recurrence (LR) rate in this group was 8.4% (2.4% per year, n = 7/83), with median time to LR of 17 months. In this no-RT group LR was correlated to ER status (2/53 ER+, 5/26ER-, p = 0.024) and margins of excision (n = 1/54 >5 mm, 2/17 1-5 mm, 4/12 <1 mm, p = 0.001). Within the ER positive group the LR rate was 0.92% per annum (0.62% per annum in patients treated with adjuvant tamoxifen, regardless of margin status). Breast cancer specific survival was correlated to histological grade (p < 0.05) and ER status (p < 0.05).
CONCLUSION
It would appear that omission of RT following successful BCS in elderly patients with ER positive tumours receiving adjuvant tamoxifen may be acceptable. The LR rate as shown in this retrospective study is highly comparable to that of younger patients treated by conventional therapy. This concept is now being evaluated prospectively following a change in treatment practice.
背景
老年乳腺癌的病程可能相对较温和。有数据表明，对于一些老年浸润性癌患者，保乳手术后可能无需进行放疗（RT）。由于年龄相关因素，手术加放疗可能会给这类患者带来负担。本研究旨在评估该组患者保乳手术（BCS）后不进行辅助放疗的疗效。
患者与方法
对92例老年患者（中位年龄75岁；范围：70 - 87岁）进行回顾性分析（因1例患者为双侧癌，故分析为93例“患者”），这些患者在专门的乳腺诊所接受了浸润性癌的保乳手术。83例患者未接受乳房术后放疗（无放疗组），其余10例接受了放疗（放疗组）。
结果
该组患者的中位年龄为75岁（范围70 - 87岁）。肿瘤平均大小为18mm，中位随访时间为37个月（范围6 - 142个月）。在无放疗组中，53例患者中有40例接受了他莫昔芬辅助内分泌治疗。雌激素受体（ER）阴性组中无患者接受他莫昔芬治疗。该组的局部复发（LR）率为8.4%（每年2.4%，n = 7/83），LR的中位时间为17个月。在该无放疗组中，LR与ER状态（53例ER + 中有2例，26例ER - 中有5例，p = 0.024）和切除边缘（n = 1/54＞5mm，2/17 1 - 5mm，4/12＜1mm，p = 0.001）相关。在ER阳性组中，LR率为每年0.92%（接受辅助他莫昔芬治疗的患者中，无论边缘状态如何，每年为0.62%）。乳腺癌特异性生存率与组织学分级（p＜0.05）和ER状态（p＜0.05）相关。
结论
对于接受辅助他莫昔芬治疗的ER阳性肿瘤老年患者，保乳手术成功后省略放疗似乎是可以接受的。本回顾性研究中显示的LR率与接受传统治疗的年轻患者的LR率高度可比。随着治疗实践的改变，这一概念目前正在进行前瞻性评估。
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