Shachar Shlomit Strulov, Jolly Trevor A, Jones Ellen, Muss Hyman B
Oncology (Williston Park). 2018 Feb 15;32(2):58-63.
Triple-negative breast cancer, which affects about 10% of older women with breast cancer, represents a major treatment challenge in this population. Treatment decisions for these patients can best be made based on geriatric assessment, estimated life expectancy, whether the treatment goal is prolonged survival or palliation, the potential benefits and toxicities of a specific treatment, and the patient's personal goals for treatment. Treatment outcomes for healthy older and younger women are similar, but great challenges exist in managing the vulnerable and frail patient. The cornerstone of therapy for early-stage triple-negative breast cancer is local therapy (surgery and radiation) and, for most patients, adjuvant chemotherapy. In the management of metastatic triple-negative breast cancer, all therapy is palliative and chemotherapy is the treatment of choice. Since all treatment modalities in older patients-especially chemotherapy-can affect physical and mental function, a geriatric assessment is key in selecting the most appropriate treatment strategy. Many older patients (older than 70 years) are poor candidates for state-of-the-art therapy, and some who have substantial comorbidities not related to breast cancer may opt for palliative and hospice care. In this review, we will discuss the role of geriatric assessment, alternative treatment modalities for older women with triple-negative breast cancer, and other special considerations for this patient population.
三阴性乳腺癌约占老年乳腺癌女性患者的10%，是这一人群面临的主要治疗挑战。对于这些患者，最佳治疗决策应基于老年评估、预期寿命、治疗目标是延长生存期还是姑息治疗、特定治疗的潜在益处和毒性以及患者的个人治疗目标。健康老年女性和年轻女性的治疗结果相似，但在管理脆弱和体弱患者方面存在巨大挑战。早期三阴性乳腺癌治疗的基石是局部治疗（手术和放疗），对大多数患者来说，还有辅助化疗。在转移性三阴性乳腺癌的管理中，所有治疗都是姑息性的，化疗是首选治疗方法。由于老年患者的所有治疗方式——尤其是化疗——都会影响身体和心理功能，因此老年评估是选择最合适治疗策略的关键。许多老年患者（70岁以上）不太适合接受最先进的治疗，一些有与乳腺癌无关的严重合并症的患者可能会选择姑息治疗和临终关怀。在这篇综述中，我们将讨论老年评估的作用、老年三阴性乳腺癌女性患者的替代治疗方式以及该患者群体的其他特殊考虑因素。
