Pinzi Valentina, Fariselli Laura, Jereczek-Fossa Barbara Alicja
Radiotherapy Unit, Neurosurgery Department, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy.
Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.
Transl Cancer Res. 2020 Jan;9(Suppl 1):S217-S227. doi: 10.21037/tcr.2019.09.39.
Radiotherapy is a pivotal treatment for treating breast cancer. However, its role in the management of elderly patients is still under debate. Some authors suggest be avoided after surgery for early stage, some others advocate its adoption. For breast cancer treatment different schedules are used both for whole and partial breast irradiation, in adjuvant as well as definitive setting. Which one is better for elderly patients is a controversial topic. Numerous studies focused on both moderate or extreme hypofractionated irradiation have been published. However, only few addressed the topic on elderly patient population. The data on hypofractionated radiotherapy showed that for whole breast, locoregional and post-mastectomy treatment, this approach is a valid option reporting similar efficacy and toxicity to the standard fractionation. Also accelerated partial breast irradiation for patients with favourable early stage disease represents a viable option allowing for de-escalation by targeting radiation dose to the part of breast tissue at highest recurrence risk. Undoubtedly, for frail and elderly patients a short course of radiotherapy could increase their adherence and the quality of life. In the same manner, the preoperative approach has been applied for both whole and partial breast irradiation, allowing for more precise target delineation compared to the post-surgical one, eventually leading to a smaller treatment volume, to less geographical missing and possibly to a lower radiation-induced toxicity. Some more long-term results could make us more confident in prescribing adjuvant or preoperative partial breast irradiation. These approaches could be the most appropriate treatment for elderly patients, potentially preserving quality of life and increasing the tolerability to the irradiation.
放射治疗是乳腺癌治疗的关键手段。然而，其在老年患者管理中的作用仍存在争议。一些作者建议早期术后避免使用，另一些则主张采用。在乳腺癌治疗中，全乳照射和部分乳腺照射在辅助治疗以及根治性治疗中都有不同的方案。哪种方案对老年患者更好是一个有争议的话题。已经发表了许多关于中等或极端大分割照射的研究。然而，只有少数研究涉及老年患者群体。大分割放射治疗的数据表明，对于全乳、局部区域和乳房切除术后治疗，这种方法是一种有效的选择，其疗效和毒性与标准分割相似。对于早期病情有利的患者，加速部分乳腺照射也是一种可行的选择，通过将辐射剂量靶向到复发风险最高的乳腺组织部分，可以降低治疗强度。毫无疑问，对于体弱和老年患者，短疗程放疗可以提高他们的依从性和生活质量。同样，术前放疗方法已应用于全乳和部分乳腺照射，与术后放疗相比，它可以更精确地划定靶区，最终缩小治疗体积，减少漏照区域，并可能降低放疗引起的毒性。一些更长期的结果可能会让我们在开具辅助或术前部分乳腺照射处方时更有信心。这些方法可能是老年患者最合适的治疗方法，有可能保持生活质量并提高对放疗的耐受性。
