Bernardi Daniele, Errante Domenico, Gallligioni Enzo, Crivellari Diana, Bianco Antonio, Salvagno Luigi, Fentiman Ian S
Division of Medical Oncology, Ospedale Civile, Vittorio Veneto, TV, Italy.
Acta Oncol. 2008;47(2):187-198. doi: 10.1080/02841860701630234.
Breast carcinoma management in the elderly often differs from the management in younger women and there is considerable controversy about what constitutes appropriate cancer care for older women. This controversy is reflected in the persistence of age-dependent variations in care over time, with older women being less likely to receive definitive care for breast cancer. There has been a significant increase in the last years in the number of studies conducted in older patients with breast cancer. Although available age-specific clinical trials data demonstrate that treatment efficacy is not modified by age, this evidence is limited by the lack of inclusion of substantial numbers of older women, particularly those of advanced age and those with comorbidities.
The literature-based evidence of the last 10 years was extensively reviewed on the main issues concerning the treatment of breast cancer in older women.
Surgical treatment in older patients has evolved from avoidance to mastectomy to breast-conserving surgery, similarly to younger patients. Given its negative effect on the quality of life, in the last few years the role of adjuvant radiotherapy has been questioned in elderly patients with breast cancer. Adjuvant chemotherapy benefit in older patients applies mainly to Estrogen-receptor-negative patients, while in Estrogen-receptor-positive patients a major role is played by endocrine treatment. New "elderly-friendly" drugs, that can help clinicians to reduce toxicity, are now available for breast cancer.
老年乳腺癌的治疗通常与年轻女性不同，对于什么构成老年女性适当的癌症治疗存在相当大的争议。这种争议反映在随着时间推移护理中年龄依赖性差异的持续存在，老年女性接受乳腺癌确定性治疗的可能性较小。近年来，针对老年乳腺癌患者的研究数量显著增加。尽管现有的特定年龄临床试验数据表明治疗效果不会因年龄而改变，但由于缺乏大量老年女性，特别是高龄和患有合并症的老年女性的纳入，这一证据受到限制。
对过去10年基于文献的关于老年女性乳腺癌治疗主要问题的证据进行了广泛回顾。
与年轻患者类似，老年患者的手术治疗已从避免乳房切除术发展为保乳手术。鉴于其对生活质量的负面影响，近年来辅助放疗在老年乳腺癌患者中的作用受到质疑。辅助化疗对老年患者的益处主要适用于雌激素受体阴性患者，而在雌激素受体阳性患者中，内分泌治疗起主要作用。现在有新的“老年友好型”药物可用于乳腺癌，有助于临床医生降低毒性。
