Breast cancer in the elderly: the role of adjuvant radiation therapy.
OBJECTIVE
To evaluate available data on breast conserving surgery (BCS) with or without radiation therapy (RT), and alternative options (e.g. Tamoxifen alone) (Tam), focusing specifically on the older patients.


METHODS
The MEDLINE was searched for the terms elderly, BCS, adjuvant/postoperative RT, Tamoxifen, and randomized trials from 1992 to 2002.


RESULTS
Authors reviewed papers of general interest on the elderly and breast cancer (BC), meta-analysis, randomized trials on BCS+/-RT and Tam+/-surgery without RT, retrospective non-randomized trials, and reported on prognostic factors for local recurrence in BCS alone, including biomarkers, attempts made to define a low-risk group, and methods of modification of the current, protracted standard adjuvant RT course.


CONCLUSIONS
Postoperative RT after BCS has a firm rationale; in current clinical practice, if the BCS+RT is medically appropriate and the patient shares the choice, after a full information of the available options and their implications, it is clinically sound to propose this approach. However, there is controversy whether a subgroup of elderly patients could be safely spared: in this setting a randomized trial is clearly warranted.
Olmi
Patrizia
P
Dipartimento di Radioterapia, Istituto Nazionale per lo Studio e la Cura dei Tumori, Via Venezian 1, 20133 Milan, Italy.
Fallai
Carlo
C
Cerrotta
Anna Maria
AM
Lozza
Laura
L
Badii
Donatella
D
D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000532:radiotherapy*; D006801:Humans; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D018570:Risk Assessment