Solin L J, Schultz D J, Fowble B L
Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia 19104, USA.
Int J Radiat Oncol Biol Phys. 1995 Aug 30;33(1):45-51. doi: 10.1016/0360-3016(95)00104-7.
The optimal management of breast cancer in elderly women is not well established. Therefore, the present study was undertaken to evaluate the outcome of breast cancer in elderly women treated with breast-conserving surgery and definitive breast irradiation.
An analysis was performed of 558 women age > or = 50 years treated with breast-conserving surgery and definitive breast irradiation for Stages I-II invasive carcinoma of the breast. Of the 558 total women, there were 173 elderly women > or = 65 years and a comparison group of 385 women age 50-64 years. Treatment for all women included complete gross excision of the primary tumor, pathologic axillary lymph node staging, and definitive breast irradiation. Adjuvant systemic chemotherapy was used in 18% (102 out of 558) of the overall group. Adjuvant tamoxifen was used in 17% (94 out of 558) of the overall group. The median follow-up after treatment was 6.2 years (mean = 6.4 years; range = 0.1-15.4 years).
Elderly patients age > or = 65 years and patients age 50-64 years were both found to have tumors with adverse prognostic features, including clinical T2 lesions (43 vs. 34%, respectively; p = 0.055), estrogen receptor negativity (9 vs. 16%, respectively; p = 0.13), and progesterone receptor negativity (17 vs. 21%, respectively; p = 0.50). Pathologic axillary lymph node staging showed that 24% of the elderly women were node positive, including 8% with four or more positive nodes, which was not different from women age 50-64 years (p = 0.23). There was no difference between the two age groups for the rate of deaths from breast cancer at 10 years (13 vs. 13%, respectively; p = 0.71). However, there was a significant difference between the two age groups for the rate of deaths from intercurrent disease at 10 years (11 vs. 2%, respectively; p = 0.0006). There were no differences between the two age groups for the 10-year rates of overall survival (77 vs. 85%, respectively; p = 0.14), relapse-free survival (64 vs. 70%, respectively; p = 0.16), freedom from distant metastases (83 vs. 78%, respectively; p = 0.45), or local failure (13 vs. 12%, respectively; p = 0.60).
These results have shown that breast carcinomas in elderly women are not indolent and have a number of adverse prognostic features. Breast-conserving surgery and definitive breast irradiation in elderly women age > or = 65 years achieves good outcomes for survival, freedom from distant metastases, and local control, which are comparable to women age 50-64 years. The causes of deaths in elderly women age > or = 65 years are from both breast cancer and intercurrent disease. Breast-conserving surgery and definitive breast irradiation should continue to be considered as a standard treatment option for appropriately selected elderly women with early-stage breast cancer.
老年女性乳腺癌的最佳治疗方案尚未完全确立。因此，本研究旨在评估保乳手术联合根治性乳腺放疗治疗老年女性乳腺癌的疗效。
对558例年龄≥50岁、接受保乳手术联合根治性乳腺放疗的Ⅰ-Ⅱ期浸润性乳腺癌女性患者进行分析。558例患者中，173例为年龄≥65岁的老年女性，385例为年龄50-64岁的女性作为对照组。所有患者的治疗均包括原发肿瘤的完整切除、腋窝淋巴结病理分期及根治性乳腺放疗。18%（558例中的102例）的患者接受了辅助性全身化疗。17%（558例中的94例）的患者接受了辅助性他莫昔芬治疗。治疗后的中位随访时间为6.2年（平均6.4年；范围0.1-15.4年）。
年龄≥65岁的老年患者和年龄50-64岁的患者均存在不良预后特征的肿瘤，包括临床T2病变（分别为43%和34%；p = 0.055）、雌激素受体阴性（分别为9%和16%；p = 0.13）以及孕激素受体阴性（分别为17%和21%；p = 0.50）。腋窝淋巴结病理分期显示，24%的老年女性淋巴结阳性，其中8%有四个或更多阳性淋巴结，这与年龄50-64岁的女性无差异（p = 0.23）。两个年龄组10年时乳腺癌死亡率无差异（分别为13%和13%；p = 0.71）。然而，两个年龄组10年时因并发疾病导致的死亡率有显著差异（分别为11%和2%；p = 0.0006）。两个年龄组10年时的总生存率（分别为77%和85%；p = 0.14）、无复发生存率（分别为64%和70%；p = 0.16）、无远处转移率（分别为83%和78%；p = 0.45）或局部失败率（分别为13%和12%；p = 0.60）均无差异。
这些结果表明，老年女性乳腺癌并非惰性肿瘤，具有许多不良预后特征。年龄≥65岁的老年女性接受保乳手术联合根治性乳腺放疗可获得良好的生存、无远处转移和局部控制效果，与年龄50-64岁的女性相当。年龄≥65岁的老年女性死亡原因包括乳腺癌和并发疾病。对于适当选择的早期乳腺癌老年女性，保乳手术联合根治性乳腺放疗应继续被视为标准治疗方案。
