Abstract
It is tempting to spare elderly women the burden of adjuvant radiotherapy after breast
cancer surgery, even if such a treatment would be justified in light of the available
clinical evidence. The reason is that evidence-based radiotherapy derives from clinical
trials that excluded elderly women, and that breast cancer is often believed to be
more indolent at advanced ages.
Unfortunately, the epidemiological evidence, and the few clinical trials recruiting
patients over 65 or 70 year of age, all point to the need for postoperative irradiation
in a similar set-up as in younger patients. So far, there is no evidence that a subgroup
exists in which radiotherapy can be safely omitted. Therefore, the decision to treat
or not to treat should be openly discussed with the patient, addressing risks and
benefits of both attitudes. Only in frail patients, with an obviously limited life
expectancy (months or at most a few years), can omission of radiotherapy be considered,
as the burden of local recurrence is likely not to appear before the patient dies
from an other cause.
Keywords
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Article info
Publication history
Published online: July 28, 2007
Accepted:
June 7,
2007
Received in revised form:
April 5,
2007
Received:
February 19,
2007
Identification
Copyright
© 2007 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
