Adjuvant hormone treatment and chemotherapy in postmenopausal women with operable breast cancer: a retrospective analysis.

Two hundred consecutive postmenopausal women with operable breast cancer and metastatic axillary nodes were treated during the period January - December 1981 with adjuvant chemotherapy (CMF) or hormonal treatment (tamoxifen). The distribution of receptor status (estrogen or progesterone), number of axillary metastatic nodes (less than = 3 or greater than 3), surgical treatment and size of the primary tumor were homogeneous in both groups. Receptor status and number of axillary lymph nodes were correlated with adjuvant treatment efficacy. Ten-year disease-free survival (DFS) was higher in the TAM-treated (72%) than in the CMF-treated group (52%) (p less than 0.01). In patients with less than = 3 axillary metastatic nodes, those treated with TAM had a higher DFS rate than those treated with CMF (75% vs 59%, p less than 0.01). There was no difference in DFS between CMF-and TAM-treated groups within the greater than 3 metastatic lymph node patients. In ER + primary tumors, DFS was higher in the subset treated with TAM (62%) than with CMF (51%) (p less than 0.05), whereas no difference in DFS was observed in ER- patients between the two treatment groups. Considering the TAM group, DFS was better (p less than 0.01) for ER+ cases than for ER- cases only at 5 years of observation. In the CMF group, DFS was not influenced by ER status. PgR content did not affect DFS in either adjuvant treatment group.     

Treatment options for early breast cancer in elderly women

In clinical practice, approximately 50% of new cases of breast cancer occur in women over the age of 65 years, although very few elderly women have been enrolled in the numerous randomized trials conducted so far. Notwithstanding less aggressive biologic features compared with younger patients, breast cancer impacts on mortality of elderly women, especially if not adequately treated. As confirmed by meta-analyses, hormonal therapy is the most effective adjuvant measure for patients with localized disease, whereas the decrease in the benefit of cytotoxic treatment with increased risk of toxicity make the decision on when and how to administer it a major challenge for the medical oncologist. Careful evaluation of biological prognostic factors, performance status and geriatric parameters, such as functional independence, comorbidities and cognitive function of the patient, along with determination of her life expectancy and preferences, represent the relevant information on which the oncologist should ground their decision for integrated treatment with conservative surgery, radiotherapy and hormonochemotherapy in otherwise healthy women, or attenuated or palliative measures for the frail patients, in order to maximize the balance of benefits and toxicities. The aims of this review are to summarize the most relevant concepts for decision making in the clinical practice and discuss the results of recent research concerning the additional needs of elderly women with early breast cancer.     

Long-term survival in elderly women receiving chemotherapy for non-metastatic breast cancer: a population-based analysis

Breast Cancer Research and Treatment - Older women are poorly represented in trials evaluating chemotherapy for breast cancer (BC). This study aimed to describe survival and associated factors...     

Increased efficacy of a dose-dense regimen of neoadjuvant chemotherapy in breast carcinoma: a retrospective analysis

Neoadjuvant chemotherapy is being increasingly used in the treatment of breast carcinoma. We performed a single-center retrospective analysis of the results of neoadjuvant therapy in 376 breast carcinoma patients treated with three different regimens combining doxorubicin and paclitaxel (AT), dose-dense doxorubicin and cyclophosphamide with sequential weekly paclitaxel (DD AC-P), or the combination of trastuzumab with chemotherapy (DD AC-PT). The expression of estrogen receptors (ER), progesterone receptors (PR) and human epidermal growth factor receptor (HER)-2 was determined immunohistochemically. Pathological response was determined in 318 patients. Pathological complete response (pCR) was observed in 18% of patients. The pCR rate was significantly higher in patients treated with DD regimen (22 vs. 13%) and younger than 55 years (23 vs. 13%). The pCR rate was higher in patients with triple negative (TN) tumors (43%) and tumors over-expressing HER-2 (HER-2+; 28%) compared to patients with ER- or PR-positive tumors not expressing HER-2 (ER/PR + HER-2?; 6%). In patients with TN tumors pCR rate was significantly higher after treatment with DD AC-P compared to AT (61 vs. 22%, p = 0.005). pCR was associated with significantly improved relapse-free survival (RFS) and overall survival (OS), but when analysis was performed based on tumor phenotype, the difference was significant only in patients with TN tumors. In multivariate analysis, pCR, stage, and ER expression were significant predictors of RFS, while pCR, stage, ER and DD regimen were significant predictors of OS. In conclusion, present data indicate superiority of a DD regimen in obtaining pCR in patients with breast carcinoma treated with neoadjuvant chemotherapy. The difference in efficacy is due mostly to markedly higher pCR rate in patients with TN tumors.     

Incidence of other cancer diagnoses in women with breast cancer: a retrospective cohort study with 42,248 women

Breast Cancer Research and Treatment - Paclitaxel, belongs to tubulin-binding agents (TBAs), shows a great efficacy against breast cancer via stabilizing microtubules. Drug resistance limits its...     

Undertreatment strongly decreases prognosis of breast cancer in elderly women.

PURPOSE: No consensus exists on therapy of elderly cancer patients. Treatments are influenced by unclear standards and are usually less aggressive. This study aims to evaluate determinants and effect of treatment choice on breast cancer prognosis among elderly patients. PATIENTS AND METHODS: We reviewed clinical files of 407 breast cancer patients aged >/= 80 years recorded at the Geneva Cancer Registry between 1989 and 1999. Patient and tumor characteristics, general health status, comorbidity, treatment, and cause of death were considered. We evaluated determinants of treatment by logistic regression and effect of treatment on mortality by Cox model, accounting for prognostic factors. RESULTS: Age was independently linked to the type of treatment. Overall, 12% of women (n = 48) had no treatment, 32% (n = 132) received tamoxifen only, 7% (n = 28) had breast-conserving surgery only, 33% (n = 133) had mastectomy, 14% (n = 57) had breast-conserving surgery plus adjuvant therapy, and 2% (n = 9) received miscellaneous treatments. Five-year specific breast cancer survival was 46%, 51%, 82%, and 90% for women with no treatment, tamoxifen alone, mastectomy, and breast-conserving surgery plus adjuvant treatment, respectively. Compared with the nontreated group, the adjusted hazard ratio of breast cancer mortality was 0.4 (95% CI, 0.2 to 0.7) for tamoxifen alone, 0.4 (95% CI, 0.1 to 1.4) for breast-conserving surgery alone, 0.2 (95% CI, 0.1 to 0.7) for mastectomy, and 0.1 (95% CI, 0.03 to 0.4) for breast-conserving surgery plus adjuvant treatment. CONCLUSION: Half of elderly patients with breast cancer are undertreated, with strongly decreased specific survival as a consequence. Treatments need to be adapted to the patient's health status, but also should offer the best chance of cure.     

FOLFOX2 regimen in the treatment of advanced colorectal cancer: a comparison between elderly and young patients.

Colorectal cancers (CRC) are primarily disease of the sixth,seventh, and eighth decades of life. The probability of developingCRC increases from 0.06% in the first four decades of life to3–4% in the sixth and seventh decades in the Western world[1]. The prevalence of the disease and     

Treatment of breast cancer in older women

Background. Breast carcinoma management in the elderly often differs from the management in younger women and there is considerable controversy about what constitutes appropriate cancer care for older women. This controversy is reflected in the persistence of age-dependent variations in care over time, with older women being less likely to receive definitive care for breast cancer. There has been a significant increase in the last years in the number of studies conducted in older patients with breast cancer. Although available age-specific clinical trials data demonstrate that treatment efficacy is not modified by age, this evidence is limited by the lack of inclusion of substantial numbers of older women, particularly those of advanced age and those with comorbidities. Method. The literature-based evidence of the last 10 years was extensively reviewed on the main issues concerning the treatment of breast cancer in older women. Results.Surgical treatment in older patients has evolved from avoidance to mastectomy to breast-conserving surgery, similarly to younger patients. Given its negative effect on the quality of life, in the last few years the role of adjuvant radiotherapy has been questioned in elderly patients with breast cancer. Adjuvant chemotherapy benefit in older patients applies mainly to Estrogen-receptor-negative patients, while in Estrogen-receptor-positive patients a major role is played by endocrine treatment. New “elderly-friendly” drugs, that can help clinicians to reduce toxicity, are now available for breast cancer.     

Response of primary breast cancer to tamoxifen alone in elderly women.

The authors report on a consecutive series of 62 evaluable, elderly (age greater than 69 years) women with primary operable breast cancer treated only with tamoxifen. The treatment schedule was 160 mg on day 1 followed by a daily maintenance dose of 20 mg. Compliance to treatment was excellent, and subjective side effects were minimal. The best response achieved after at least 6 months of treatment was complete in 7, partial in 22 and minor in 3, whereas stable disease or progression was observed in 28 and 2 patients, respectively. The response rate decreased and progressions increased with time. At 6, 12, 24, 36 and 48 months of treatment, the complete + partial response rates were 30.6%, 45%, 45.6%, 38.7% and 25% and the progressive disease rates 4.8%, 19.6%, 34.8%, 45.2% and 66.6%, respectively. These results do not confirm some previous reports of a high response to tamoxifen. This difference is only partially explained by the use of mammography, which is more sensitive than palpation, to assess tumor size and treatment response. The present study does not support primary hormone therapy as a current alternative to surgery, which should be the standard treatment in otherwise healthy elderly patients with operable breast cancer.     

老年乳腺癌患者应用非蒽环类辅助化疗方案的安全性及耐受性临床研究

背景与目的：乳腺癌发病率随年龄增长而升高,老年患者占有较大的比例。但由于老年患者所接受的治疗不足、合并症多、身体一般状况差,预后往往较年轻患者差。本研究观察我国老年乳腺癌患者应用以紫杉类为主的非蒽环类辅助化疗方案的安全性和耐受性。方法：2008年11月—2012年1月共有56例接受手术治疗的老年乳腺癌患者,以2∶1比例(≥65岁)入TC组(4或6个周期的多西他赛75 mg/m2和环磷酰胺600 mg/m2,35例)和PC组(4或6个周期的紫杉醇175 mg/m2和环磷酰胺600 mg/m2,21例)。在化疗结束后,根据患者病情,继续进行局部放射治疗和(或)内分泌治疗。结果：本研究共有50例患者按计划完成化疗,2组完成计划化疗的比例均在90%以上。中位随访33个月,中位无复发生存和总生存时间均未达到。PC组和TC组2年无病生存率分别为89.5%(17/19)和90.3%(28/31);2年生存率分别为100%和96.8%(30/31)。非蒽环类辅助化疗方案的主要不良反应为Ⅲ～Ⅳ度中性粒细胞减少、白细胞减少以及Ⅰ～Ⅳ度的脱发、胃肠道反应和周围神经毒性。2组相比,PC组更易出现Ⅲ～Ⅳ度中性粒细胞减少(76.2% vs 48.6%,P=0.044)和不同程度的周围神经毒性(9.5% vs 2.9%)。不能耐受化疗相关不良反应是患者提前终止化疗和减少化疗药物剂量的主要原因。结论：非蒽环类化疗方案的耐受性及安全性好,老年乳腺癌患者能较好地接受以紫杉类为主的化疗方案。PC方案在耐受性和安全性上与TC方案相当,为我国老年乳腺癌患者增加一个安全、低毒的化疗方案的选择。     

早期乳腺癌乳房保留治疗的疗效分析

目的 评价早期乳腺癌保乳术后伞乳放疗的生存率和局部.区域控制率,探讨影响局部控制的因素.方法 近10年收治的早期乳腺癌接受保乳术者335例,其中术后单纯放疗、序贯化放疗、同期放化疗、化放化疗分别为25、194、80、36例.312例接受腋窝淋巴结清扫,2例前哨淋巴结活榆.310例接受辅助化疗.256放疗范围为单纯乳房,79例包括区域淋巴结照射.全乳和区域淋巴结照射剂量为50 Gy分25次,中位瘤床剂量为60 Gy分30次.放疗和手术间隔时问<4、4～8、>8～20、>20周的比例分别为16.4%、23.6%、37.3%、22.7%.结果 中位随访期48.0个月(25.3～146.7个月).5年局部一区域控制率和同侧乳房控制率分别为94.5%和95.6%;5年无病生存率、无转移牛存牢和总生俘率分别为88.6%、93.2%和98.8%.单因素分析发现脉管受侵、神经受侵犯和Ⅱ期切除的5年局部控制率下降,手术与放疗间隔时间、化疗与放疗结合方式的局部榨制率均相似.多因素分析发现脉管侵犯和Ⅱ期切除是独立的预后因素.序贯化放疗+单纯放疗、同期放化疗、化放化疗≥3级皮肤反应(湿性脱皮)发生率分别为4.5%、80.0%、77.0%(χ2=226.00,P=0.000).结论 早期乳腺癌保乳术加术后伞乳放疗等可获得良好的局部控制率和牛存率.脉管受侵与否和Ⅱ期切除是影响局部控制率的独立预后因素.未发现手术与放疗间隔时间、放疗与化疗结合方式对局部控制率有影响,但同期放化疗或化放化疗者发生皮肤湿性脱皮的概率明显增高.     

Incidence of breast cancer in Italy: mastectomies and quadrantectomies performed between 2000 and 2005

Objectives

We aimed to determine the incidence of women''s breast cancer in Italy without using statistical approximations.

Methods

We analyzed the national hospitalizations database at the Ministry of Health to calculate the number of major surgeries in Italian women (mastectomies and quadrantectomies) due to breast cancer between 2000 and 2005, overall and by age groups (<44, 45–64, 65–74 and ≥ 75 years old).

Results

Over the six years examined, an overall number of 100,745 mastectomies and 168,147 quadrantectomies were performed. A total of 41,608 major surgeries due to breast cancer were performed in the year 2000 and this number rose to 47,200 in 2005, with a 13.4% increase over six years.

Conclusion

by analyzing the hospitalizations database concerning major breast surgery, incidence of breast cancer in Italy was found to be 26.5% higher than the official estimations which have been computed using statistical models (namely 47,200 vs. 37,300 cases in year 2005).     

Initial experiences of women from hereditary breast cancer families after bilateral prophylactic mastectomy: a retrospective study.

BACKGROUND: Women from families with breast and/or ovarian cancers seek advice and counselling for risk assessment, but they also want information about preventive measures that might reduce their risk of developing these neoplasms. PATIENTS AND METHODS: This study was undertaken in order to assess 15 women's experience with the decision-making process prior to undergoing prophylactic bilateral mastectomy (PM) and immediate breast reconstruction (IBR). It was also designed to determine the degree of the women's satisfaction with the information delivered by the different caregivers, and whether the women felt that their need for psychosocial support was appropriately met. An additional goal was to learn about the patients> satisfaction with the operations. RESULTS: The women found it difficult to translate the genetic information transmitted to them, although they were satisfied by the way it was given. At some stage during the pre-operative and post-operative period nearly all women stated that they lacked psychological support from the different caregivers. No woman regretted her choice to undergo PM and IBR. By far, the most important issue was the actual risk reduction. However, the result exceeded all patients' initial expectations. When performing PM and IBR, a multidisciplinary team approach, including a psychologist, seems mandatory. It will facilitate the overall management of this group of women.     

Treatment of estrogen deficiency symptoms in women surviving breast cancer. Part 2: Hormone replacement therapy and breast cancer

There are several million breast cancer survivors worldwide. In the United States, 180,000 women were diagnosed with breast cancer in 1997, and approximately 97,000 of these women have an extremely low chance of suffering a recurrence of their cancer. With an average age at diagnosis of 60 years and a 25-year expected duration of survival, the current number of breast cancer survivors in the United States may approach 2.5 million women. Since breast cancer is now being detected at an earlier stage than previously and since adjuvant chemotherapy may cause ovarian failure, an increasing number of women are becoming postmenopausal at a younger age after breast cancer treatment. This conference was convened in September 1997 to consider how menopausal breast cancer survivors should be treated at the present time and what future studies are needed to develop improved therapeutic strategies. A total of 59 breast cancer experts and patient advocates participated. The proceedings of the conference will be published in six installments in successive issues of ONCOLOGY. The first part, published last month, defined the problem and explored its magnitude and ramifications for patient management. This second part focuses on the benefits and risks of hormone replacement therapy (HRT) in patients with breast cancer.