Tagliaferri Luca, Lancellotta Valentina, Colloca Giuseppe, Marazzi Fabio, Masiello Valeria, Garganese Giorgia, Kovács György, Valentini Vincenzo, Gambacorta Maria Antonietta
UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
J Oncol. 2020 Feb 28;2020:3928976. doi: 10.1155/2020/3928976. eCollection 2020.
. Elderly patients are underrepresented from a majority of clinical trials and the choice of the best treatment becomes a challenge. The optimal treatment should be personalized and based on a multidisciplinary approach that includes radiation oncologists, surgeons, geriatricians, medical oncologists, social workers, and support services. The global evaluation of the patients and the creation of nomograms may facilitate the definition of long-term treatment benefits minimizing the use of unnecessary therapy. . A systematic research using PubMed, Scopus, and Cochrane library was performed to identify full articles analyzing the efficacy of APBI in elderly patients with breast cancer. ClinicalTrials.gov was searched for ongoing or recently completed trials, and PROSPERO was searched for ongoing or recently completed systematic reviews.
Seven papers fulfilled the eligibility criteria. The number of evaluated patients was 405 and the median age was 77.7 years. The disease-free survival (DFS) range was 96.1%-100%, the grade 3-4 toxicity range was 0%-6.6%, the cancer-specific survival (CSS) range was 97.9%-100%, and the overall survival (OS) range was 87%-100%. All studies reported excellent/good cosmetic results in a range of 74% to 99%.
Accelerated partial breast irradiation (APBI) results in a safe and effective substitute for the adjuvant external beam radiotherapy in selected elderly early-stage breast cancer patients. Based on the relatively low toxicity, APBI should be advised in selected patients with life expectancies larger than 5-10 years.
大多数临床试验中老年患者的代表性不足，因此选择最佳治疗方案成为一项挑战。最佳治疗方案应个性化，并基于多学科方法，包括放射肿瘤学家、外科医生、老年病学家、医学肿瘤学家、社会工作者和支持服务。对患者进行全面评估并创建列线图可能有助于确定长期治疗益处，同时尽量减少不必要治疗的使用。使用PubMed、Scopus和Cochrane图书馆进行了系统研究，以识别分析加速部分乳腺照射（APBI）对老年乳腺癌患者疗效的全文。在ClinicalTrials.gov上搜索正在进行或最近完成的试验，并在PROSPERO上搜索正在进行或最近完成的系统评价。
七篇论文符合纳入标准。评估患者数量为405例，中位年龄为77.7岁。无病生存率（DFS）范围为96.1%-100%，3-4级毒性范围为0%-6.6%，癌症特异性生存率（CSS）范围为97.9%-100%，总生存率（OS）范围为87%-100%。所有研究均报告美容效果良好/优秀，范围在74%至99%之间。
对于部分选定的老年早期乳腺癌患者，加速部分乳腺照射（APBI）可安全有效地替代辅助外照射放疗。基于相对较低的毒性，对于预期寿命大于5至10年的选定患者，建议采用APBI。
