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Hypofractionated radiotherapy and hormonal therapy without surgery for breast carcinoma in elderly patients
Breast cancer management in the elderly is and will continue to be a major health problem. Because mass screening does not extend to elderly patients who are sometimes reluctant to seek medical advice, breast cancer is often diagnosed at an advanced stage. Some of them do not accept surgery. In addition, comorbid disease is often associated with old age, and may present a contraindication to anaesthesia. Under these circumstances, the least disturbing medical solution has a chance to be accepted by the patient and her family. In
the Cancer Centre of Nice, long-term results of adjuvant hypofractionated
irradiation to elderly patients with breast cancer were excellent (Ortholan
et al., 2005). We have adopted the same schedule to definitive
radiotherapy, with a higher total dose. This treatment was associated with
hormonal therapy in hormone positive tumours, usually given for 3 to 6
months prior to radiotherapy, leading to more than halving the tumour
volume. Five fractions of 6.5 Gy once weekly were given to the whole
breast, followed by 2 to 3 fractions of 6.5 Gy to the tumour site. The
5-year local-progression-free rate as assessed by clinical examination and
breast imaging was 78%. Cause-specific survival was 71%, and was mainly
influenced by tumour size, nodal status and oestrogen receptors. Overall
survival was 38%, quite good in a population with a median age of 83, and
was affected by tumour size and performance status. Hypofractionated
irradiation carries the risk of increasing late effects. These were mild
to moderate in 87% of the cases, and were accepted by these patients. Withholding surgery in old patients with breast cancer is not recommended, unless the patient or her family refuses operation, or there is contraindication to anaesthesia. Once weekly irradiation associated with hormonal therapy is a good alternative in such conditions, allowing good local control with acceptable toxicity.
Bibliographical reference: Adel Courdi Radiotherapy Department, Centre Antoine-Lacassagne, Nice Cedex, France
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