Garg Praveen, Rana Fauzia, Gupta Ruchi, Buzaianu Elena M, Guthrie Troy H
Department of Medicine, Division of Hematology-Oncology, University of Florida, Jacksonville, Florida 32207, USA.
Breast J. 2009 Jul-Aug;15(4):404-8. doi: 10.1111/j.1524-4741.2009.00745.x. Epub 2009 Jun 9.
Women older than 70 years have been underrepresented in breast cancer adjuvant chemotherapy trials due to concerns about toxicity, safety and tolerance of chemotherapy. The aim of our study was to assess the tolerance of chemotherapy in older women with breast cancer and determine patterns of toxicity including the impact of age, chemotherapy regimen, functional status and comorbid conditions on this toxicity. We retrospectively reviewed the charts of early stage (stages 1 and 2) breast cancer patients older than 70 years from 1998 to 2004. A total of 62 patients, with mean age of 74.3 years, were identified. Chemotherapy was completed in 89% patients. Overall 79% completed chemotherapy without any significant side-effects, dose reductions, or breaks during chemotherapy. Using logistic regression model increasing age was not associated with early termination of chemotherapy (p = 0.19, OR: 0.868, 95% CI: 0.7-1.076). However, increasing age, lower functional status, and higher comorbidity index scores were associated with reduction in dose and breaks in chemotherapy. None of the patients who received pegfilgrastim prophylactically developed high-grade neutropenia. Our study suggests that adjuvant chemotherapy is safe in elderly patients. Older patients with good functional status and low comorbidity index scores tolerate chemotherapy as well as the younger patients. Prophylactic use of pegfilgrastim may reduce occurrence of severe neutropenia and related toxicity such as febrile neutropenia in the elderly patient.
由于担心化疗的毒性、安全性和耐受性，70岁以上的女性在乳腺癌辅助化疗试验中的代表性不足。我们研究的目的是评估老年乳腺癌女性对化疗的耐受性，并确定毒性模式，包括年龄、化疗方案、功能状态和合并症对这种毒性的影响。我们回顾性分析了1998年至2004年70岁以上早期（1期和2期）乳腺癌患者的病历。共确定了62例患者，平均年龄74.3岁。89%的患者完成了化疗。总体而言，79%的患者在化疗期间完成化疗且无任何明显副作用、剂量减少或中断。使用逻辑回归模型，年龄增加与化疗早期终止无关（p = 0.19，OR：0.868，95% CI：0.7 - 1.076）。然而，年龄增加、功能状态较低和合并症指数评分较高与化疗剂量减少和中断有关。预防性接受培非格司亭的患者均未发生重度中性粒细胞减少。我们的研究表明，辅助化疗在老年患者中是安全的。功能状态良好且合并症指数评分低的老年患者对化疗的耐受性与年轻患者相同。预防性使用培非格司亭可能会降低老年患者严重中性粒细胞减少及相关毒性（如发热性中性粒细胞减少）的发生率。
