Adjuvant therapeutic decisions in elderly breast cancer patients: the role of chemotherapy in a retrospective analysis.
OBJECTIVE
Decisions on the type of adjuvant treatment in older breast cancer patients are challenging. Side effects of chemotherapy have to be weighed against life expectancy, comorbidities, functional status, and frailty on the basis of studies usually excluding patients over 69 years. To aid this decision, we analyzed a database of 6000 unselected patients and of those evaluated elderly primary breast cancer patients with hormone receptor-negative tumors from 1963 until 2003 in respect of survival data depending on adjuvant treatment.


METHODS
A total of 131 elderly (i.e., >65 years) patients were observed retrospectively for a median of 72 months. Patients received breast-conserving therapy or mastectomy and adjuvant radiotherapy, chemotherapy, and endocrine therapy. Data were collected from a hospital-intern database.


RESULTS
Median age at diagnosis was 72 years. Mostly, tumors were small (81 % T1, 17 % T2) but of unfavorable grading (40 % G2, 35 % G3). Lymph nodes were positive in 42 %. Mastectomy was performed in 65 %. While 42 % of patients received radiotherapy, only 10 % were treated with chemotherapy. Patients with G2 and G3 tumors (p = 0.027), younger women (p = 0.012), and patients with positive lymph node status (p < 0.0001) more likely received chemotherapy. Recurrence-free survival was longer in patients without chemotherapy (37 vs. 29 months, p = 0.234). Overall survival was non-significantly shorter in patients who received chemotherapy (59 vs. 81 months, p = 0.131).


CONCLUSIONS
In this analysis, adjuvant chemotherapy was not associated with improved survival, presumably caused by an a priori poor prognosis of these patients. For an aging society more data are urgently needed to help selecting and personalizing adjuvant treatment within subgroups of breast cancer in older women.
Department of Gynecology and Obstetrics, Ludwig-Maximilians-University Munich, Campus Innenstadt, Maistr. 11, 80337, Munich, Germany. julia.jueckstock@med.uni-muenchen.de.
J
J
Jueckstock
Department of Cardiology, Klinikum Hamburg-Harburg, Hamburg, Germany.
F
F
Kasch
Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany.
B
B
Jaeger
Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany.
A
A
Schramm
Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany.
W
W
Janni
Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany.
C
C
Scholz
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008408:Mastectomy; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
Breast cancer; Elderly patients; Neoplasm metastasis; Neoplasm recurrence; Survival