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- Title
Adjuvant chemotherapy in older and younger women with lymph node-positive breast cancer.
- Authors
Muss HB; Woolf S; Berry D; Cirrincione C; Weiss RB; Budman D; Wood WC; Henderson IC; Hudis C; Winer E; Cohen H; Wheeler J; Norton L; Cancer and Leukemia Group B; Muss, Hyman B; Woolf, Susan; Berry, Donald; Cirrincione, Constance; Weiss, Raymond B; Budman, Daniel
- Abstract
<bold>Context: </bold>Adjuvant chemotherapy improves survival for patients with local-regional breast cancer, but healthy older patients at high risk of recurrence are frequently not offered adjuvant chemotherapy, and the benefit of adjuvant chemotherapy in older patients is uncertain.<bold>Objective: </bold>To compare the benefits and toxic effects of adjuvant chemotherapy among breast cancer patients in age groups of 50 years or younger, 51 to 64 years, and 65 years or older.<bold>Design and Setting: </bold>Retrospective review of data from 4 randomized trials that accrued patients from academic and community medical centers between 1975 and 1999. Median follow-up for all patients was 9.6 years. All trials randomized patients to different regimens, doses, schedules, and durations of chemotherapy and all had a treatment arm with doses or schedules that were regarded to be "high" and potentially more toxic.<bold>Patients: </bold>A total of 6487 women with lymph node-positive breast cancer; 542 (8%) patients were 65 years or older and 159 (2%) were 70 years or older.<bold>Main Outcome Measure: </bold>Comparison of disease-free survival, overall survival, and treatment-related mortality among different age groups.<bold>Results: </bold>Multivariate analysis showed that smaller tumor size, fewer positive lymph nodes, more chemotherapy, and tamoxifen use were all significantly (P<.001) related to longer disease-free and overall survival. There was no association between age and disease-free survival. Overall survival was significantly (P<.001) worse for patients aged 65 or older because of death from causes other than breast cancer. Thirty-three deaths (0.5% of all patients) were attributed to treatment, and older women had higher treatment-related mortality. Older women and younger women derived similar reductions in breast cancer mortality and recurrence from regimens containing more chemotherapy.<bold>Conclusion: </bold>Age alone should not be a contraindication to the use of optimal chemotherapy regimens in older women who are in good general health.
- Publication
JAMA: Journal of the American Medical Association, 2005, Vol 293, Issue 9, p1073
- ISSN
0098-7484
- Publication type
journal article
- DOI
10.1001/jama.293.9.1073