No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
162 Geriatric assessment in oncology: a tool to provide better cancer care in the elderly
ResearchGate has not been able to resolve any citations for this publication.
In women 70 years of age or older who have early breast cancer, it is unclear whether lumpectomy plus tamoxifen is as effective as lumpectomy followed by tamoxifen plus radiation therapy.
Between July 1994 and February 1999, we randomly assigned 636 women who were 70 years of age or older and who had clinical stage I (T1N0M0 according to the tumor-node-metastasis classification), estrogen-receptor-positive breast carcinoma treated by lumpectomy to receive tamoxifen plus radiation therapy (317 women) or tamoxifen alone (319 women). Primary end points were the time to local or regional recurrence, the frequency of mastectomy for recurrence, breast-cancer-specific survival, the time to distant metastasis, and overall survival.
The only significant difference between the two groups was in the rate of local or regional recurrence at five years (1 percent in the group given tamoxifen plus irradiation and 4 percent in the group given tamoxifen alone, P<0.001). There were no significant differences between the two groups with regard to the rates of mastectomy for local recurrence, distant metastases, or five-year rates of overall survival (87 percent in the group given tamoxifen plus irradiation and 86 percent in the tamoxifen group, P=0.94). Assessment by physicians and patients of cosmetic results and adverse events uniformly rated tamoxifen plus irradiation inferior to tamoxifen alone.
Lumpectomy plus adjuvant therapy with tamoxifen alone is a realistic choice for the treatment of women 70 years of age or older who have early, estrogen-receptor-positive breast cancer.
One reason for obvious differences in cancer treatment of elderly patients, compared to younger patients, may be the fear of reduced tolerance at a higher age. The purpose of the study was to document acute tolerance of radiotherapy with curative intent in patients > 74 years old. Special emphasis was given to 72 patients treated to large volumes and/or high doses for gynecological carcinomas, prostate cancer of subsites of the head and neck requiring bilateral treatment of the neck including major parts of the pharynx and larynx.
From January 1991 to May 1995, 210 consecutive patients entered a prospective study to assess acute toxicity of radiotherapy given with curative intent. Median age was 79.3 (74.4 to 93.7) years. Fifty-three percent received postoperative radiotherapy, 47% radiotherapy alone. Radiation technique, fractionation and doses were the same as applied in younger patients. Tolerance was scored using a 5-point scale; in addition, pre- and post-treatment Karnofsky performance status and body weight were assessed.
Acute toxicity leads to a dose reduction in 3 patients. The death of 1 patient with Hodgkin's disease was attributable to large field radiotherapy, and 1 case of grade 4 cystitis was noted in a patient with prostate cancer. Radiotherapy for breast cancer with or without lymph nodes imposed no problem. With appropriate supportive measures, even hyperfractionated or accelerated radiotherapy regimens for carcinomas of the head and neck were feasible in elderly patients. Radiotherapy to the pelvic region lead to severe diarrhea requiring medication in 20% of the patients. For all areas treated, higher age within the range of > 74 to < 94 years did not increase the severity of the acute radiation reactions.
Using the same treatment schedules and techniques of radiotherapy as for younger patients, curative radiotherapy is well tolerated in patients aged > 74 years treated even when major parts of the pharynx and larynx or large volumes of the pelvis are included. Small bowel reaction (diarrhea) and pharyngeal mucositis deserve special attention and supportive care in elderly patients prone to a rapidly symptomatic dehydration.
Less extensive treatment and inferior prognosis for breast cancer patients in older women
- R Ballard-Barbash
- Al Potosky
- Harian
- Lc
Ballard-Barbash R, Potosky AL, Harian LC et al. Less extensive treatment and inferior prognosis for breast cancer patients in older women. J Natl Cancer Inst 1996;88:716–726.
A randomised controlled trial of breast conserving surgery in a minimum-risk older population. The PRIME trial
- Prescott Rj Kunkler
- Ih
- Williams
- Lj
Prescott RJ, Kunkler IH, Williams LJ et al. A randomised controlled trial of breast conserving surgery in a minimum-risk older population. The PRIME trial. Health Technol Assess 2007;11:1–149.