Adjuvant radiotherapy on older and oldest breast cancer patients after conservative surgery: a retrospective analysis.
Purpose of this study was to evaluate the impact of adjuvant radiotherapy, in terms of feasibility and activity, in women aged ≥ 75 years with early (stage) breast cancer. From January 2000 to December 2007, 131 consecutive patients aged 75 years or older received adjuvant radiotherapy after breast conserving surgery. Eighty-two patients received radiotherapy in combination with 5 years of hormone therapy with tamoxifen or aromatase inhibitor. Thirty out of 131 received chemotherapy. Variables considered were age, stage, co-morbidity, performance status, radiation dose (boost), hormone therapy and chemotherapy. The mean age was 78.3 years (range 75-88 years). A total of 19.1% of the patients had no co-morbidity, 57.38% mild, 19.8% moderate, and 3.8% had severe co-morbidities. All patients but one completed the planned radiation schedule. At a median follow-up of 56 months, the 5-year overall survival rate was 78.8%. There was a better survival for patients with no or mild co-morbidities (p<0.0001). The disease-free survival at 5 years was 89.6%. No difference in acute and late toxicity rates was found between patients with different ACE-27 (Adult Comorbidity Evaluation-27) indexes and for different age. We conclude that compliance with adjuvant radiotherapy is good and rate of toxicity is acceptable in elderly patients. Patients with no or mild co-morbidities have a significantly better survival. Increasing severity of co-morbidity may sufficiently shorten remaining life expectancy to cancel gains with adjuvant radiotherapy. Further prospective trials are needed to confirm these results.
Department of Radiation Oncology, Arcispedale S. Anna Universitary Hospital, C. so Giovecca 203, I-44100 Ferrara, Italy. francesco.fiorica@unife.it
Francesco
F
Fiorica
Massimiliano
M
Berretta
Stefano
S
Ursino
Rossella
R
Fisichella
Arben
A
Lleshi
Gerlando
G
Fiorica
Antonio
A
Stefanelli
Giampaolo
G
Zini
Umberto
U
Tirelli
Antonio
A
Zanghi
Alessandro
A
Cappellani
Salvatore
S
Berretta
Francesco
F
Cartei
D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D047072:Aromatase Inhibitors / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy / Q000379:methods; D015897:Comorbidity; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental / Q000379:methods; D010349:Patient Compliance; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013629:Tamoxifen / Q000627:therapeutic use; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D047072:Aromatase Inhibitors; D013629:Tamoxifen