Breast Cancer Research and Treatment

, Volume 81, Issue 3, pp 243–251 | Cite as

Breast Cancer in Elderly Women: is Partial Breast Irradiation a Good Alternative?

  • J.M. Hannoun-Levi
  • A. Courdi
  • H. Marsiglia
  • M. Namer
  • J.P. Gerard
Article

Abstract

Background. Approximately half of all breast cancer occurs after age 65. Several aspects for the treatment of early breast cancer may be influenced by patient age, including postoperative radiation therapy (RT), in order to prevent the risk of local recurrence (LR). Postoperative adjuvant RT, improving the chances of local control, is not always completed because of comorbidity-associated factors. Does an alternative exist between a 5-week radiotherapy regime and no irradiation after breast conservative surgery without burdening the overall therapeutic management?

Methods. The authors review the literature regarding age-specific issues in the irradiation of breast cancer and the potential role of a partial breast irradiation (PBI) to prevent LR in the ipsilateral breast.

Results. Phase II and III trials have been analyzed for feasibility, efficacy and toxicity. PBI may be delivered with low or high dose rate brachytherapy and intra operative, or external beam radiation therapy. PBI satisfies the control quality criteria. The majority of the teams provide PBI recurrence rates lower than 5% (0–4.4%) with a median follow-up varying between 8 and 72 months, associated with cosmetic results comparable to those achieved with conventional external beam.

Conclusions. Breast cancer in elderly women represents a medical and economical problem. The recommended conservative treatment includes RT for 50 Gy over 5 weeks. Some subgroups of patients did not receive radiotherapy because of comorbidity-associated factors or more favorable tumor biology. PBI seems to be an acceptable alternative to adjuvant RT over 5 weeks and no irradiation. The evaluation of toxicity and efficacy, especially in terms of local control, is necessary and large multicentric phase III trials comparing the two irradiation approaches are needed, including quality of life, economic considerations and longer follow-up.

breast cancer elderly partial irradiation 

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Copyright information

© Kluwer Academic Publishers 2003

Authors and Affiliations

  • J.M. Hannoun-Levi
    • 1
  • A. Courdi
    • 1
  • H. Marsiglia
    • 2
    • 3
  • M. Namer
    • 4
  • J.P. Gerard
    • 1
  1. 1.Department of Radiation OncologyCenter Antoine LacassagneNiceItaly
  2. 2.Department of Radiation OncologyInstitut Gustave RoussyVillejuifFrance
  3. 3.Brachytherapy Unit, Radiation Oncology DepartmentEuropean Institute of OncologyMilanItaly
  4. 4.Department of Medical OncologyCenter Antoine LacassagneNiceItaly

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