Díaz Gavela Ana Aurora, Vaquero Barrón Blanca, Del Cerro Peñalver Elia, Couñago Felipe
Department of Radiation Oncology, Hospital Universitario Quironsalud Madrid, Madrid, Spain.
Department of Radiation Oncology, Hospital Quironsalud La Luz, Madrid, Spain.
Transl Cancer Res. 2020 Jan;9(Suppl 1):S37-S55. doi: 10.21037/tcr.2019.07.09.
In developed countries, breast cancer (BC) is the most common type of cancer in women, mainly affecting patients over age 60. Due to the increasing life expectancy and population ageing, the incidence of BC is expected to increase significantly in the coming years. However, no standardized clinical guidelines are available to assist in decision-making in elderly patients. Moreover, there is a lack of quality scientific evidence to guide treatment selection in this patient population, who are underrepresented in clinical trials. Consequently, up to 50% of elderly women are treated suboptimally, which implies a worse prognosis and survival. Given that the current estimated life expectancy of a healthy 70-year-old woman is 15 years, any treatment capable of reducing the likelihood of disease recurrence and cancer-specific mortality in this patient population would be beneficial. Adjuvant radiotherapy (RT) is one of the pillars of treatment for BC and it plays a key role in improving local control (LC) and overall survival (OS). Adjuvant RT is clearly indicated in young patients who undergo breast-conserving surgery (BCS) as well as in high risk patients, regardless of age. However, the use of adjuvant RT in older patients with early-stage disease has decreased in recent years-even in patients who undergo BCS-due to outdated concerns about the possible side effects of RT and reports suggesting that RT can be omitted in low-risk patients. One of the greatest challenges currently facing radiation oncologists who specialise in the treatment of BC is the selection of elderly patients who are likely to benefit from adjuvant RT. There is also a clear need to critically evaluate the available evidence and to apply those findings to routine clinical practice. Given this context, the aim of the present review is to clarify the current role of adjuvant RT in the management of BC in older women-particularly those with early-stage disease-and to dispel the myths surrounding the use of RT to treat elderly women. This review primarily focuses on the indications, controversies, and irradiation techniques used in this patient subgroup.
在发达国家，乳腺癌（BC）是女性中最常见的癌症类型，主要影响60岁以上的患者。由于预期寿命的增加和人口老龄化，预计未来几年BC的发病率将显著上升。然而，目前尚无标准化的临床指南可协助老年患者进行决策。此外，缺乏高质量的科学证据来指导该患者群体的治疗选择，而这些患者在临床试验中的代表性不足。因此，高达50%的老年女性接受的治疗并不理想，这意味着预后和生存率较差。鉴于目前健康的70岁女性的预期寿命估计为15年，任何能够降低该患者群体疾病复发可能性和癌症特异性死亡率的治疗方法都将是有益的。辅助放疗（RT）是BC治疗的支柱之一，在改善局部控制（LC）和总生存期（OS）方面发挥着关键作用。辅助RT在接受保乳手术（BCS）的年轻患者以及高危患者中均有明确指征，无论年龄大小。然而，近年来，早期疾病老年患者辅助RT的使用有所减少，即使是接受BCS的患者，这是由于对RT可能的副作用存在过时的担忧，以及有报告表明低风险患者可以省略RT。目前，专门从事BC治疗的放射肿瘤学家面临的最大挑战之一是选择可能从辅助RT中获益的老年患者。显然也需要严格评估现有证据并将这些发现应用于常规临床实践。在此背景下，本综述的目的是阐明辅助RT在老年女性BC管理中的当前作用，特别是那些患有早期疾病的女性，并消除围绕使用RT治疗老年女性的误解。本综述主要关注该患者亚组中使用的指征、争议和照射技术。
