Management of early breast cancer in older women: from screening to treatment
Identifieur interne : 007635 ( Ncbi/Merge ); précédent : 007634; suivant : 007636Management of early breast cancer in older women: from screening to treatment
Auteurs : Fadwa Elomrani [Maroc] ; Maryem Zine [Maroc] ; Mohamed Afif [Maroc] ; Saad L Nnaz [Maroc] ; Imane Ouziane [Maroc] ; Hind Mrabti [Maroc] ; Hassan Errihani [Maroc]Source :
- Breast Cancer : Targets and Therapy [ 1179-1314 ] ; 2015.
Abstract
Breast cancer is a common condition. It is a leading cause of death among women, and its incidence increases with age. Aging of the population and improvement of the quality of life of elders make it a major public health issue. We reviewed the literature to try to determine the management of breast cancer in older women.
We conducted a narrative review by literature searches using key words “breast cancer”, “elderly and older”, and “women” in Pubmed, Scopus, and Google Scholar. The aim of this review is to summarize the management of early breast cancer in older women by discussing the controversies of screening in older women. Then, we try to define the optimal strategy for these women, either surgery alone or primary endocrine therapy. We also discuss the indications of lymph node dissection, and we evaluate the benefit of adjuvant radiotherapy, chemotherapy, and the anti HER2 treatment for these women.
More than 50% of patients with breast cancer are 65 years or older, and around 30% are more than 70 years old. Most randomized trials did not include older women. Hence, the treatment of breast cancer in older patients is based on the management provided to younger women. Regardless of age, the treatment must aim for the best efficiency. Advanced age in itself should not be a limitation to treatment. There are no standard guidelines set for elderly patients. Surgical treatment for older patients evolved to avoid mastectomy, and conservative mammary surgery was proposed, similar to that used in younger patients. The proportion of elderly patients receiving adjuvant radiotherapy is increasing. The role of adjuvant radiotherapy in older patients with breast cancer was analyzed. Adjuvant chemotherapy is beneficial to women with hormone receptor-negative tumors. In those with hormone receptor-positive tumors, adjuvant chemotherapy in association to trastuzumab is beneficial for HER2-positive tumors, and for women with HER2-negative tumors adjuvant hormonal therapy is a very good option.
Breast cancer is common in older women. This population requires particular and adapted management. It is essential for older patients to be included in new clinical trials for individualized treatment recommendation.
Url:
DOI: 10.2147/BCTT.S87125
PubMed: 26185468
PubMed Central: 4500607
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xml:lang="fr">Maroc</country><wicri:regionArea>Department of Onco Hematology, Military Hospital Mohamed V, Rabat</wicri:regionArea><placeName><settlement type="city">Rabat</settlement><region nuts="2">Rabat-Salé-Kénitra</region></placeName></affiliation></author><author><name sortKey="Afif, Mohamed" sort="Afif, Mohamed" uniqKey="Afif M" first="Mohamed" last="Afif">Mohamed Afif</name><affiliation wicri:level="3"><nlm:aff id="af3-bctt-7-165">Department of Radiotherapy, National Institute of Oncology, Rabat, Morocco</nlm:aff><country xml:lang="fr">Maroc</country><wicri:regionArea>Department of Radiotherapy, National Institute of Oncology, Rabat</wicri:regionArea><placeName><settlement type="city">Rabat</settlement><region nuts="2">Rabat-Salé-Kénitra</region></placeName></affiliation></author><author><name sortKey="L Nnaz, Saad" sort="L Nnaz, Saad" uniqKey="L Nnaz S" first="Saad" last="L Nnaz">Saad L Nnaz</name><affiliation wicri:level="3"><nlm:aff id="af1-bctt-7-165">Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco</nlm:aff><country xml:lang="fr">Maroc</country><wicri:regionArea>Department of Medical Oncology, National Institute of Oncology, Rabat</wicri:regionArea><placeName><settlement type="city">Rabat</settlement><region nuts="2">Rabat-Salé-Kénitra</region></placeName></affiliation></author><author><name sortKey="Ouziane, Imane" sort="Ouziane, Imane" uniqKey="Ouziane I" first="Imane" last="Ouziane">Imane Ouziane</name><affiliation wicri:level="3"><nlm:aff id="af1-bctt-7-165">Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco</nlm:aff><country xml:lang="fr">Maroc</country><wicri:regionArea>Department of Medical Oncology, National Institute of Oncology, Rabat</wicri:regionArea><placeName><settlement type="city">Rabat</settlement><region nuts="2">Rabat-Salé-Kénitra</region></placeName></affiliation></author><author><name sortKey="Mrabti, Hind" sort="Mrabti, Hind" uniqKey="Mrabti H" first="Hind" last="Mrabti">Hind Mrabti</name><affiliation wicri:level="3"><nlm:aff id="af1-bctt-7-165">Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco</nlm:aff><country xml:lang="fr">Maroc</country><wicri:regionArea>Department of Medical Oncology, National Institute of Oncology, Rabat</wicri:regionArea><placeName><settlement type="city">Rabat</settlement><region nuts="2">Rabat-Salé-Kénitra</region></placeName></affiliation></author><author><name sortKey="Errihani, Hassan" sort="Errihani, Hassan" uniqKey="Errihani H" first="Hassan" last="Errihani">Hassan Errihani</name><affiliation wicri:level="3"><nlm:aff id="af1-bctt-7-165">Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco</nlm:aff><country xml:lang="fr">Maroc</country><wicri:regionArea>Department of Medical Oncology, National Institute of Oncology, Rabat</wicri:regionArea><placeName><settlement type="city">Rabat</settlement><region 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screening to treatment</title><author><name sortKey="Elomrani, Fadwa" sort="Elomrani, Fadwa" uniqKey="Elomrani F" first="Fadwa" last="Elomrani">Fadwa Elomrani</name><affiliation wicri:level="3"><nlm:aff id="af1-bctt-7-165">Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco</nlm:aff><country xml:lang="fr">Maroc</country><wicri:regionArea>Department of Medical Oncology, National Institute of Oncology, Rabat</wicri:regionArea><placeName><settlement type="city">Rabat</settlement><region nuts="2">Rabat-Salé-Kénitra</region></placeName></affiliation></author><author><name sortKey="Zine, Maryem" sort="Zine, Maryem" uniqKey="Zine M" first="Maryem" last="Zine">Maryem Zine</name><affiliation wicri:level="3"><nlm:aff id="af2-bctt-7-165">Department of Onco Hematology, Military Hospital Mohamed V, Rabat, Morocco</nlm:aff><country xml:lang="fr">Maroc</country><wicri:regionArea>Department of Onco Hematology, Military Hospital Mohamed V, Rabat</wicri:regionArea><placeName><settlement type="city">Rabat</settlement><region nuts="2">Rabat-Salé-Kénitra</region></placeName></affiliation></author><author><name sortKey="Afif, Mohamed" sort="Afif, Mohamed" uniqKey="Afif M" first="Mohamed" last="Afif">Mohamed Afif</name><affiliation wicri:level="3"><nlm:aff id="af3-bctt-7-165">Department of Radiotherapy, National Institute of Oncology, Rabat, Morocco</nlm:aff><country xml:lang="fr">Maroc</country><wicri:regionArea>Department of Radiotherapy, National Institute of Oncology, Rabat</wicri:regionArea><placeName><settlement type="city">Rabat</settlement><region nuts="2">Rabat-Salé-Kénitra</region></placeName></affiliation></author><author><name sortKey="L Nnaz, Saad" sort="L Nnaz, Saad" uniqKey="L Nnaz S" first="Saad" last="L Nnaz">Saad L Nnaz</name><affiliation wicri:level="3"><nlm:aff id="af1-bctt-7-165">Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco</nlm:aff><country xml:lang="fr">Maroc</country><wicri:regionArea>Department of Medical Oncology, National Institute of Oncology, Rabat</wicri:regionArea><placeName><settlement type="city">Rabat</settlement><region nuts="2">Rabat-Salé-Kénitra</region></placeName></affiliation></author><author><name sortKey="Ouziane, Imane" sort="Ouziane, Imane" uniqKey="Ouziane I" first="Imane" last="Ouziane">Imane Ouziane</name><affiliation wicri:level="3"><nlm:aff id="af1-bctt-7-165">Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco</nlm:aff><country xml:lang="fr">Maroc</country><wicri:regionArea>Department of Medical Oncology, National Institute of Oncology, Rabat</wicri:regionArea><placeName><settlement type="city">Rabat</settlement><region nuts="2">Rabat-Salé-Kénitra</region></placeName></affiliation></author><author><name sortKey="Mrabti, Hind" sort="Mrabti, Hind" uniqKey="Mrabti H" first="Hind" last="Mrabti">Hind Mrabti</name><affiliation wicri:level="3"><nlm:aff id="af1-bctt-7-165">Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco</nlm:aff><country xml:lang="fr">Maroc</country><wicri:regionArea>Department of Medical Oncology, National Institute of Oncology, Rabat</wicri:regionArea><placeName><settlement type="city">Rabat</settlement><region nuts="2">Rabat-Salé-Kénitra</region></placeName></affiliation></author><author><name sortKey="Errihani, Hassan" sort="Errihani, Hassan" uniqKey="Errihani H" first="Hassan" last="Errihani">Hassan Errihani</name><affiliation wicri:level="3"><nlm:aff id="af1-bctt-7-165">Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco</nlm:aff><country xml:lang="fr">Maroc</country><wicri:regionArea>Department of Medical Oncology, National Institute of Oncology, Rabat</wicri:regionArea><placeName><settlement type="city">Rabat</settlement><region nuts="2">Rabat-Salé-Kénitra</region></placeName></affiliation></author></analytic><series><title level="j">Breast Cancer : Targets and Therapy</title><idno type="eISSN">1179-1314</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Breast cancer is a common condition. It is a leading cause of death among women, and its incidence increases with age. Aging of the population and improvement of the quality of life of elders make it a major public health issue. We reviewed the literature to try to determine the management of breast cancer in older women.</p></sec><sec><title>Methods</title><p>We conducted a narrative review by literature searches using key words “breast cancer”, “elderly and older”, and “women” in Pubmed, Scopus, and Google Scholar. The aim of this review is to summarize the management of early breast cancer in older women by discussing the controversies of screening in older women. Then, we try to define the optimal strategy for these women, either surgery alone or primary endocrine therapy. We also discuss the indications of lymph node dissection, and we evaluate the benefit of adjuvant radiotherapy, chemotherapy, and the anti HER2 treatment for these women.</p></sec><sec><title>Results</title><p>More than 50% of patients with breast cancer are 65 years or older, and around 30% are more than 70 years old. Most randomized trials did not include older women. Hence, the treatment of breast cancer in older patients is based on the management provided to younger women. Regardless of age, the treatment must aim for the best efficiency. Advanced age in itself should not be a limitation to treatment. There are no standard guidelines set for elderly patients. Surgical treatment for older patients evolved to avoid mastectomy, and conservative mammary surgery was proposed, similar to that used in younger patients. The proportion of elderly patients receiving adjuvant radiotherapy is increasing. The role of adjuvant radiotherapy in older patients with breast cancer was analyzed. Adjuvant chemotherapy is beneficial to women with hormone receptor-negative tumors. In those with hormone receptor-positive tumors, adjuvant chemotherapy in association to trastuzumab is beneficial for HER2-positive tumors, and for women with HER2-negative tumors adjuvant hormonal therapy is a very good option.</p></sec><sec><title>Conclusion</title><p>Breast cancer is common in older women. This population requires particular and adapted management. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Breast Cancer (Dove Med Press)</journal-id><journal-id journal-id-type="iso-abbrev">Breast Cancer (Dove Med Press)</journal-id><journal-id journal-id-type="publisher-id">Breast Cancer: Targets and Therapy</journal-id><journal-title-group><journal-title>Breast Cancer : Targets and Therapy</journal-title></journal-title-group><issn pub-type="epub">1179-1314</issn><publisher><publisher-name>Dove Medical Press</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">26185468</article-id><article-id pub-id-type="pmc">4500607</article-id><article-id pub-id-type="doi">10.2147/BCTT.S87125</article-id><article-id pub-id-type="publisher-id">bctt-7-165</article-id><article-categories><subj-group subj-group-type="heading"><subject>Review</subject></subj-group></article-categories><title-group><article-title>Management of early breast cancer in older women: from screening to treatment</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Elomrani</surname><given-names>Fadwa</given-names></name><xref ref-type="aff" rid="af1-bctt-7-165">1</xref><xref ref-type="corresp" rid="c1-bctt-7-165"></xref></contrib><contrib contrib-type="author"><name><surname>Zine</surname><given-names>Maryem</given-names></name><xref ref-type="aff" rid="af2-bctt-7-165">2</xref></contrib><contrib contrib-type="author"><name><surname>Afif</surname><given-names>Mohamed</given-names></name><xref ref-type="aff" rid="af3-bctt-7-165">3</xref></contrib><contrib contrib-type="author"><name><surname>L’annaz</surname><given-names>Saad</given-names></name><xref ref-type="aff" rid="af1-bctt-7-165">1</xref></contrib><contrib contrib-type="author"><name><surname>Ouziane</surname><given-names>Imane</given-names></name><xref ref-type="aff" rid="af1-bctt-7-165">1</xref></contrib><contrib contrib-type="author"><name><surname>Mrabti</surname><given-names>Hind</given-names></name><xref ref-type="aff" rid="af1-bctt-7-165">1</xref></contrib><contrib contrib-type="author"><name><surname>Errihani</surname><given-names>Hassan</given-names></name><xref ref-type="aff" rid="af1-bctt-7-165">1</xref></contrib></contrib-group><aff id="af1-bctt-7-165"><label>1</label>Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco</aff><aff id="af2-bctt-7-165"><label>2</label>Department of Onco Hematology, Military Hospital Mohamed V, Rabat, Morocco</aff><aff id="af3-bctt-7-165"><label>3</label>Department of Radiotherapy, National Institute of Oncology, Rabat, Morocco</aff><author-notes><corresp id="c1-bctt-7-165">Correspondence: Fadwa Elomrani, Department of Medical Oncology, National Institute of Oncology, Avenue Allal Fassi, Ryad, Rabat, Morocco, Email <email>elomranifadwa@gmail.com</email></corresp></author-notes><pub-date pub-type="collection"><year>2015</year></pub-date><pub-date pub-type="epub"><day>07</day><month>7</month><year>2015</year></pub-date><volume>7</volume><fpage>165</fpage><lpage>171</lpage><permissions><copyright-statement>© 2015 Elomrani et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License</copyright-statement><copyright-year>2015</copyright-year><license><license-p>The full terms of the License are available at <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">http://creativecommons.org/licenses/by-nc/3.0/</ext-link>. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.</license-p></license></permissions><abstract><sec><title>Background</title><p>Breast cancer is a common condition. It is a leading cause of death among women, and its incidence increases with age. Aging of the population and improvement of the quality of life of elders make it a major public health issue. We reviewed the literature to try to determine the management of breast cancer in older women.</p></sec><sec><title>Methods</title><p>We conducted a narrative review by literature searches using key words “breast cancer”, “elderly and older”, and “women” in Pubmed, Scopus, and Google Scholar. The aim of this review is to summarize the management of early breast cancer in older women by discussing the controversies of screening in older women. Then, we try to define the optimal strategy for these women, either surgery alone or primary endocrine therapy. We also discuss the indications of lymph node dissection, and we evaluate the benefit of adjuvant radiotherapy, chemotherapy, and the anti HER2 treatment for these women.</p></sec><sec><title>Results</title><p>More than 50% of patients with breast cancer are 65 years or older, and around 30% are more than 70 years old. Most randomized trials did not include older women. Hence, the treatment of breast cancer in older patients is based on the management provided to younger women. Regardless of age, the treatment must aim for the best efficiency. Advanced age in itself should not be a limitation to treatment. There are no standard guidelines set for elderly patients. Surgical treatment for older patients evolved to avoid mastectomy, and conservative mammary surgery was proposed, similar to that used in younger patients. The proportion of elderly patients receiving adjuvant radiotherapy is increasing. The role of adjuvant radiotherapy in older patients with breast cancer was analyzed. Adjuvant chemotherapy is beneficial to women with hormone receptor-negative tumors. In those with hormone receptor-positive tumors, adjuvant chemotherapy in association to trastuzumab is beneficial for HER2-positive tumors, and for women with HER2-negative tumors adjuvant hormonal therapy is a very good option.</p></sec><sec><title>Conclusion</title><p>Breast cancer is common in older women. This population requires particular and adapted management. It is essential for older patients to be included in new clinical trials for individualized treatment recommendation.</p></sec></abstract><kwd-group><title>Keywords</title><kwd>breast cancer</kwd><kwd>elderly women</kwd><kwd>chemotherapy</kwd><kwd>surgery</kwd><kwd>radiotherapy</kwd><kwd>hormonal therapy</kwd></kwd-group></article-meta></front><floats-group><table-wrap id="t1-bctt-7-165" position="float"><label>Table 1</label><caption><p>The incidence and the mortality of breast cancer in France</p></caption><table frame="hsides" rules="groups"><thead><tr><th valign="top" align="left" rowspan="1" colspan="1">Age (years)</th><th valign="top" align="left" rowspan="1" colspan="1">Incidence/100,000</th><th valign="top" align="left" rowspan="1" colspan="1">Mortality/100,000</th></tr></thead><tbody><tr><td valign="top" align="left" rowspan="1" colspan="1">60–64</td><td valign="top" align="left" rowspan="1" colspan="1">299.8</td><td valign="top" align="left" rowspan="1" colspan="1">61.3</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">65–69</td><td valign="top" align="left" rowspan="1" colspan="1">386.1</td><td valign="top" align="left" rowspan="1" colspan="1">73.4</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">70–74</td><td valign="top" align="left" rowspan="1" colspan="1">341.8</td><td valign="top" align="left" rowspan="1" colspan="1">84.6</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">75–79</td><td valign="top" align="left" rowspan="1" colspan="1">295.8</td><td valign="top" align="left" rowspan="1" colspan="1">101.2</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">80–84</td><td valign="top" align="left" rowspan="1" colspan="1">304.4</td><td valign="top" align="left" rowspan="1" colspan="1">132.6</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">85–89</td><td valign="top" align="left" rowspan="1" colspan="1">338</td><td valign="top" align="left" rowspan="1" colspan="1">183</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">90–94</td><td valign="top" align="left" rowspan="1" colspan="1">283.6</td><td valign="top" align="left" rowspan="1" colspan="1">273.9</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">>95</td><td valign="top" align="left" rowspan="1" colspan="1">255.3</td><td valign="top" align="left" rowspan="1" colspan="1">309.9</td></tr></tbody></table></table-wrap><table-wrap id="t2-bctt-7-165" position="float"><label>Table 2</label><caption><p>Summary of different studies comparing surgery ± hormonal therapy in older women</p></caption><table frame="hsides" rules="groups"><thead><tr><th valign="top" align="left" rowspan="1" colspan="1">Name of study</th><th valign="top" align="left" rowspan="1" colspan="1">Number of patients included</th><th valign="top" align="left" rowspan="1" colspan="1">Study design</th><th valign="top" align="left" rowspan="1" colspan="1">Median duration of survival (years)</th><th valign="top" align="left" rowspan="1" colspan="1">Progression-free survival</th><th valign="top" align="left" rowspan="1" colspan="1">Overall survival</th></tr></thead><tbody><tr><td valign="top" align="left" rowspan="1" colspan="1">EORTC 10851 (UK) (Fentiman et al<xref rid="b14-bctt-7-165" ref-type="bibr">14</xref>)</td><td valign="top" align="left" rowspan="1" colspan="1">164</td><td valign="top" align="left" rowspan="1" colspan="1">Surgery vs tamoxifen 20 mg/d</td><td valign="top" align="left" rowspan="1" colspan="1">10</td><td valign="top" align="left" rowspan="1" colspan="1">63/82 vs 69/82<xref ref-type="table-fn" rid="tfn1-bctt-7-165">#</xref><break></break>HR: 0.55</td><td valign="top" align="left" rowspan="1" colspan="1">60/82 vs 50/82<xref ref-type="table-fn" rid="tfn1-bctt-7-165">#</xref><break></break>HR: 1.11 (0.75–1.65)<xref ref-type="table-fn" rid="tfn2-bctt-7-165">$</xref></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Nottingham (UK) (Robertson et al<xref rid="b12-bctt-7-165" ref-type="bibr">12</xref>)</td><td valign="top" align="left" rowspan="1" colspan="1">131</td><td valign="top" align="left" rowspan="1" colspan="1">Surgery vs tamoxifen 40 mg/d</td><td valign="top" align="left" rowspan="1" colspan="1">5</td><td valign="top" align="left" rowspan="1" colspan="1">56/65 vs 57/66<xref ref-type="table-fn" rid="tfn1-bctt-7-165">#</xref><break></break>HR: not estimated</td><td valign="top" align="left" rowspan="1" colspan="1">28/65 vs 28/66<xref ref-type="table-fn" rid="tfn1-bctt-7-165">#</xref><break></break>HR: 1.06 (0.59–1.92)<xref ref-type="table-fn" rid="tfn2-bctt-7-165">$</xref></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">St Georges (UK) (Gazet et al<xref rid="b13-bctt-7-165" ref-type="bibr">13</xref>)</td><td valign="top" align="left" rowspan="1" colspan="1">200</td><td valign="top" align="left" rowspan="1" colspan="1">Surgery vs tamoxifen 20 mg/j</td><td valign="top" align="left" rowspan="1" colspan="1">6</td><td valign="top" align="left" rowspan="1" colspan="1">60/100 vs 70/100<xref ref-type="table-fn" rid="tfn1-bctt-7-165">#</xref><break></break>HR: not estimated</td><td valign="top" align="left" rowspan="1" colspan="1">28/100 vs 33/100<xref ref-type="table-fn" rid="tfn1-bctt-7-165">#</xref><break></break>HR: 0.75 (0.44–1.26)<xref ref-type="table-fn" rid="tfn2-bctt-7-165">$</xref></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">CRC (UK) (Fennessey et al<xref rid="b20-bctt-7-165" ref-type="bibr">20</xref>)</td><td valign="top" align="left" rowspan="1" colspan="1">455</td><td valign="top" align="left" rowspan="1" colspan="1">Surgery plus tamoxifen 40 mg/j vs tamoxifen only</td><td valign="top" align="left" rowspan="1" colspan="1">13</td><td valign="top" align="left" rowspan="1" colspan="1">Not reported</td><td valign="top" align="left" rowspan="1" colspan="1">159/225 vs 187/230<xref ref-type="table-fn" rid="tfn1-bctt-7-165">#</xref><break></break>HR: 0.78 (0.63–0.96)<xref ref-type="table-fn" rid="tfn2-bctt-7-165">$</xref></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">GRETA (Italy) (Mustacchi et al<xref rid="b15-bctt-7-165" ref-type="bibr">15</xref>)</td><td valign="top" align="left" rowspan="1" colspan="1">274</td><td valign="top" align="left" rowspan="1" colspan="1">Surgery plus radiotherapy plus tamoxifen 20 mg/d vs tamoxifen only</td><td valign="top" align="left" rowspan="1" colspan="1">7</td><td valign="top" align="left" rowspan="1" colspan="1">140/239 vs 188/235<xref ref-type="table-fn" rid="tfn1-bctt-7-165">#</xref><break></break>HR: 0.65 (0.53–0.81)<xref ref-type="table-fn" rid="tfn2-bctt-7-165">$</xref></td><td valign="top" align="left" rowspan="1" colspan="1">130/239 vs 144/235<xref ref-type="table-fn" rid="tfn1-bctt-7-165">#</xref><break></break>HR: 0.98 (0.77–1.25)<xref ref-type="table-fn" rid="tfn2-bctt-7-165">$</xref></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Naples (Italy) (Capasso et al<xref rid="b21-bctt-7-165" ref-type="bibr">21</xref>)</td><td valign="top" align="left" rowspan="1" colspan="1">75</td><td valign="top" align="left" rowspan="1" colspan="1">Surgery plus radiotherapy plus tamoxifen<break></break>20 mg/d vs tamoxifen only 160 mg/d then 20 mg/d until progression</td><td valign="top" align="left" rowspan="1" colspan="1">10</td><td valign="top" align="left" rowspan="1" colspan="1">9/38 vs 13/37<xref ref-type="table-fn" rid="tfn1-bctt-7-165">#</xref><break></break><italic>P</italic>=0.4594</td><td valign="top" align="left" rowspan="1" colspan="1">121 months vs 123 months<break></break><italic>P</italic>=0.8</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Nottingham.2 (UK) (Willsher et al<xref rid="b19-bctt-7-165" ref-type="bibr">19</xref>)</td><td valign="top" align="left" rowspan="1" colspan="1">147</td><td valign="top" align="left" rowspan="1" colspan="1">Surgery plus tamoxifen vs tamoxifen 20 mg/j</td><td valign="top" align="left" rowspan="1" colspan="1">5</td><td valign="top" align="left" rowspan="1" colspan="1">Not reported</td><td valign="top" align="left" rowspan="1" colspan="1">8/53 vs 14/94<xref ref-type="table-fn" rid="tfn1-bctt-7-165">#</xref><break></break>HR: 0.80 (0.73–2.32)<xref ref-type="table-fn" rid="tfn2-bctt-7-165">$</xref></td></tr></tbody></table><table-wrap-foot><fn><p><bold>Notes:</bold></p></fn><fn id="tfn1-bctt-7-165"><label>#</label><p>Number of patients who have progressed by the total number of patients included in each arms of the study;</p></fn><fn id="tfn2-bctt-7-165"><label>$</label><p>data are expressed in months, and values in parentheses indicate the confidence interval of hazard ratio.</p></fn><fn id="tfn3-bctt-7-165"><p><bold>Abbreviation:</bold> HR, hazard ratio; d, day.</p></fn></table-wrap-foot></table-wrap><table-wrap id="t3-bctt-7-165" position="float"><label>Table 3</label><caption><p>Summary of different studies comparing adjuvant hormonal therapy with tamoxifen vs placebo in older women</p></caption><table frame="hsides" rules="groups"><thead><tr><th valign="top" align="left" rowspan="1" colspan="1">Name of study</th><th valign="top" align="left" rowspan="1" colspan="1">Study design</th><th valign="top" align="left" rowspan="1" colspan="1">Median duration of follow-up</th><th valign="top" align="left" rowspan="1" colspan="1">Progression-free survival</th><th valign="top" align="left" rowspan="1" colspan="1">Overall survival</th></tr></thead><tbody><tr><td valign="top" align="left" rowspan="1" colspan="1">Castiglone et al<xref rid="b38-bctt-7-165" ref-type="bibr">38</xref></td><td valign="top" align="left" rowspan="1" colspan="1">the study included 320 patients aged between 66 and 80 years. They received Tamoxifen 20mg/day and prednisone</td><td valign="top" align="left" rowspan="1" colspan="1">96 months</td><td valign="top" align="left" rowspan="1" colspan="1">36% vs 22%<break></break><italic>P</italic>=0.004</td><td valign="top" align="left" rowspan="1" colspan="1">49% vs 42%<break></break><italic>P</italic>=0.43</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Crivellari et al<xref rid="b41-bctt-7-165" ref-type="bibr">41</xref></td><td valign="top" align="left" rowspan="1" colspan="1">349 patients included aged between 66 and 80 years. Mastectomy followed by tamoxifen and prednisone vs no treatment</td><td valign="top" align="left" rowspan="1" colspan="1">21 years</td><td valign="top" align="left" rowspan="1" colspan="1">Improvement of progression free survival (<italic>P</italic>=0.003)</td><td valign="top" align="left" rowspan="1" colspan="1">Improvement of 15 years overall survival and relapse-free survival, 10%±3% vs 19%±3%<break></break>HR, 0.71;<xref ref-type="table-fn" rid="tfn4-bctt-7-165">$</xref> 95% CI, 0.58 to 0.86<xref ref-type="table-fn" rid="tfn4-bctt-7-165">$</xref></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Mouridsen et al<xref rid="b40-bctt-7-165" ref-type="bibr">40</xref></td><td valign="top" align="left" rowspan="1" colspan="1">509 patients included were 70 years old or more tamoxifen and local irradiation vs irradiation only</td><td valign="top" align="left" rowspan="1" colspan="1">6 years</td><td valign="top" align="left" rowspan="1" colspan="1">48% vs 39%<break></break><italic>P</italic>=0.0008</td><td valign="top" align="left" rowspan="1" colspan="1">No difference in overall survival</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Cummings et al<xref rid="b39-bctt-7-165" ref-type="bibr">39</xref></td><td valign="top" align="left" rowspan="1" colspan="1">181 patients included were 65–84 years old tamoxifen over 2 years vs placebo</td><td valign="top" align="left" rowspan="1" colspan="1">10 years</td><td valign="top" align="left" rowspan="1" colspan="1">7.4 vs 4.4 years<break></break><italic>P</italic>=0.001</td><td valign="top" align="left" rowspan="1" colspan="1">8.5 vs 8 years<break></break><italic>P</italic>=0.063</td></tr></tbody></table><table-wrap-foot><fn><p><bold>Note:</bold></p></fn><fn id="tfn4-bctt-7-165"><label>$</label><p>Data are expressed in months.</p></fn><fn id="tfn5-bctt-7-165"><p><bold>Abbreviations:</bold> CI, confidence interval; HR, hazard ratio.</p></fn></table-wrap-foot></table-wrap></floats-group></pmc><affiliations><list><country><li>Maroc</li></country><region><li>Rabat-Salé-Kénitra</li></region><settlement><li>Rabat</li></settlement></list><tree><country name="Maroc"><region name="Rabat-Salé-Kénitra"><name sortKey="Elomrani, Fadwa" sort="Elomrani, Fadwa" uniqKey="Elomrani F" first="Fadwa" last="Elomrani">Fadwa Elomrani</name></region><name sortKey="Afif, Mohamed" sort="Afif, Mohamed" uniqKey="Afif M" first="Mohamed" last="Afif">Mohamed Afif</name><name sortKey="Errihani, Hassan" sort="Errihani, Hassan" uniqKey="Errihani H" first="Hassan" last="Errihani">Hassan Errihani</name><name sortKey="L Nnaz, Saad" sort="L Nnaz, Saad" uniqKey="L Nnaz S" first="Saad" last="L Nnaz">Saad L Nnaz</name><name sortKey="Mrabti, Hind" sort="Mrabti, Hind" uniqKey="Mrabti H" first="Hind" last="Mrabti">Hind Mrabti</name><name sortKey="Ouziane, Imane" sort="Ouziane, Imane" uniqKey="Ouziane I" first="Imane" last="Ouziane">Imane Ouziane</name><name sortKey="Zine, Maryem" sort="Zine, Maryem" uniqKey="Zine M" first="Maryem" last="Zine">Maryem Zine</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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