School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Department of Pharmacy, Chi Mei Medical Center, Tainan City, Taiwan.
Breast Cancer. 2024 Sep;31(5):739-753. doi: 10.1007/s12282-024-01622-1. Epub 2024 Aug 1.
Insufficient data available for older patients with breast cancer complicates decision-making regarding optimal treatment. A systematic review that uses real-world data is required for assessing the effectiveness and potential adverse effects of various therapies for this age group of patients.
Databases of PubMed, Embase, and Cochrane Library were searched. We included clinical studies that evaluated various treatments for geriatric breast cancer, including adjuvant radiation therapy, hypofractionated radiation therapy (hypo-RT) and accelerated and partial breast irradiation (APBI), endocrine therapy, chemotherapy, and targeted therapy.
A total of 71 studies were retrieved. Adjuvant radiation therapy significantly improved overall survival (OS) compared with no radiation [hazard ratio (HR) = 0.60, 95% confidence interval (CI) 0.54-0.67]. The pooled estimates of OS for hypo-RT and APBI demonstrated no inferiority compared with conventional radiation. Both endocrine treatment (HR = 0.63, 95% CI 0.43-0.92) and chemotherapy (HR = 0.76, 95% CI 0.65-0.88) significantly increased OS compared with no treatment. Trastuzumab monotherapy significantly enhanced OS compared with no trastuzumab use (HR = 0.23, 95% CI 0.07-0.73).
Despite concerns about potential complications during treatment in older patients, proactive therapies significantly increase their survival rates. For patients who are frailer, hypo-RT and APBI offer survival rates comparable to traditional modalities. Additionally, targeted therapy as a monotherapy holds promise as a viable option for patients with HER2-positive breast cancer who cannot undergo chemotherapy. Therefore, by conducting thorough general assessments and clinical evaluations, the side effects of postoperative treatments can be effectively managed.
针对患有乳腺癌的老年患者，目前可用的数据不足，这使得针对这一年龄段患者的最佳治疗方案的决策变得复杂。需要进行一项使用真实世界数据的系统评价，以评估各种疗法对该年龄组患者的有效性和潜在不良影响。
检索了 PubMed、Embase 和 Cochrane Library 数据库。我们纳入了评估老年乳腺癌各种治疗方法的临床研究，包括辅助放疗、低分割放疗（hypo-RT）和加速部分乳房照射（APBI）、内分泌治疗、化疗和靶向治疗。
共检索到 71 项研究。与无放疗相比，辅助放疗显著提高了总生存（OS）[风险比（HR）=0.60，95%置信区间（CI）0.54-0.67]。低分割放疗和 APBI 的 OS 汇总估计结果表明，与常规放疗相比，并无劣势。内分泌治疗（HR=0.63，95%CI 0.43-0.92）和化疗（HR=0.76，95%CI 0.65-0.88）均显著提高了 OS。与不使用曲妥珠单抗相比，曲妥珠单抗单药治疗显著提高了 OS（HR=0.23，95%CI 0.07-0.73）。
尽管老年患者在治疗期间存在潜在并发症的担忧，但积极治疗显著提高了他们的生存率。对于身体更虚弱的患者，低分割放疗和 APBI 提供的生存率与传统方式相当。此外，作为单一疗法的靶向治疗作为不能进行化疗的 HER2 阳性乳腺癌患者的可行选择具有一定前景。因此，通过进行全面的一般评估和临床评估，可以有效管理术后治疗的副作用。
