[Effective treatment strategy in elderly breast cancer patients].
BACKGROUND
High frequency of cancer in older people and the improvements in life expectancy do not allow older age to be a barrier to treatment. The age is one of the risk factors for breast cancer development, one third of all cases occur in women older than 70 years.


OBJECTIVE
To provide an overview of the available information on the main issues in the field of surgery, radiotherapy and medical approaches to the treatment of breast cancer in the elderly.


METHODS
The author discusses the treatment of breast cancer in the elderly, based on the data of literature.


RESULTS
The assessment of any patient is the first step in the treatment process, performance status is more important than age. In older women a correct evaluation includes not only the basic medical history and the cancer staging, but also a detailed assessment of health and environment that may interfere with the therapeutic approach of the patient. Age is not a limitation for surgery, without any comorbidity it is safe, and operative mortality is low. The body self-image is important for most old women, they also wish to keep their breasts, so a conservative surgery and adjuvant radiotherapy should be offered to all, as long as the stage permits it. The selection of patients who are candidates for axillary dissection is based on selective lymph sentinel node technique which provides an optimal nodal staging with a minimal morbidity. The results of radiotherapy are as good as in younger patients, elderly women tolerate radiotherapy well. The inability to travel to the radiation facility is often the reason for omitting the radiation treatment and to choose a modified mastectomy. A promising alternative to the standard radiation treatment is the concept of intraoperative radiotherapy. Breast cancer in the elderly women is more likely to be well differentiated tumour, containing oestrogen and progesterone receptors. Based on these favourable prognostic factors, endocrine therapy is the standard treatment in adjuvant and metastatic setting for older women. When all hormonal options have been exhausted, elderly women should be treated with chemotherapy. Older patients often use several drugs concomitantly, and this polypharmacy may lead to possible clinically significant changes in the cytotoxic agent pharmacology. Supportive care can improve compliance of patients to chemotherapy. The introduction of oral and weekly applied cytotoxic treatments will allow a broader spectrum of patients to benefit from chemotherapy, particularly those with a poorer performance status.


CONCLUSIONS
The use of a multidimensional geriatric evaluation permits a better selection of the best and individualized therapeutic decision for each patient. The growing number of treatment options in the elderly breast cancer patients will lead to an increase in survival and contribute to an improvement in their quality of life.
Boér
Katalin
K
Szent Margit Kórház Onkológiai Osztály, Budapest. katalin.boer@oncology.hu
D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001365:Axilla; D001828:Body Image; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D004347:Drug Interactions; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008408:Mastectomy / Q000379:methods; D019338:Polypharmacy; D011379:Prognosis; D011788:Quality of Life; D018714:Radiotherapy, Adjuvant
D018931:Antineoplastic Agents, Hormonal