International Journal of Radiation Oncology*Biology*Physics
Clinical investigation: CervixLong-term results of adjuvant hypofractionated radiotherapy for breast cancer in elderly patients
Introduction
Elderly breast cancer management will be a major public health concern in the next few years. Old age is one of the greatest risk factors for breast cancer (1) and the incidence of breast cancer in elderly women is constantly increasing. Few data are available on treatment of these patients, because they have been poorly represented in prospective clinical trials (2). Although breast carcinoma in the elderly generally presents with more biologically favorable prognostic factors than in the younger patient (3), the disease is often diagnosed at a more advanced stage owing to negligence or the absence of a screening program at this age. In addition, these patients sometimes present with several comorbidities that often lead to undertreatment. Epidemiologic reviews have shown that elderly women are less likely to receive the standard locoregional treatment, especially radiotherapy (RT) 4, 5, 6, 7, 8. The treatment of these patients should consider not only the breast cancer prognosis, but also life expectancy, quality of life, and the patient's wishes. Less cumbersome therapeutic alternatives that could secure good tumor control without altering the quality of life are highly needed. We have developed a hypofractionated once-weekly RT regimen to treat these patients as adjuvant therapy. The preliminary data have been previously presented (9) and have been updated in this study with an adequate number of patients and sufficient follow-up. Emphasis was on early and late sequelae and patient outcome.
Section snippets
Patients
Between 1987 and 1999, 150 patients presenting with 151 primary breast tumors (Stage I–III) underwent a schedule of adjuvant, postoperative, once-weekly, hypofractionated RT. The mean age of the population was 76.6 ± 0.7 years (median, 78 years). Of the 150 patients, 17 were <70 years old and were treated with this scheme because of associated disease and/or a long distance between their home and the RT facility. Forty-three patients (28.5%) underwent mastectomy, generally because of tumor
Early and late effects
Early reactions, mainly erythema, were observed in 42 patients, with a Kaplan-Meier estimate and standard error of 26.5% ± 4%. They were classified as Grade 1 in 28 cases and Grade 2 in 14 cases. The corresponding Kaplan-Meier estimates were 18.6% ± 3% and 9.4% ± 3% (Fig. 1). . No Grade 3 effects occurred. Patients who had received a boost to the tumor bed had a 37% ± 7% probability of early effects of either grade vs. 22% ± 4% in those having received only the five weekly fractions (p = 0.01;
Discussion
In the 1960s, different hypofractionation schedules were evaluated as palliative treatment of breast cancer 14, 15, 16. Because of the poor radiation quality and technique, the severity of late effects led to abandonment of those protocols. More recently, adjuvant hypofractionated and accelerated RT schedules have been evaluated in Phase III randomized trials. These trials compared 23 Gy in 4 fractions within 17 days (17) or 42.5 Gy in 16 fractions within 22 days vs. standard RT (18).
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