Breast cancer irradiation in elderly

In Western countries, about 25% of breast cancers (BC) occur in women older than 70 years old. Local control is a crucial step to cure disease, because locoregional relapse (LRR) is a major risk factor of subsequent metastases. After mastectomy, radiotherapy (RT) confirmed a very high value (regardless of age) in several trials and meta-analyses, especially in case of high LRR risk factors (i.e. axillary nodal involvement). Globally, RT reduces LRR rates by 60-70% and also increases long-term survival rates by 8-9%. After breast conserving surgery, several trials and meta-analyses confirmed that RT decreases 10-year local recurrence rates from 20-25 to 5-8%. RT replacement by hormonal treatment leads to a significantly higher LRR rate. Hypofractionated RT schemes could usefully apply to elderly people, but partial breast irradiation techniques are still under investigation. Finally, all elderly fitted women should receive adjuvant RT according to general guidelines with optimal technique in order to avoid cardiotoxicity. Indeed, under-treatment has an unfavourable effect on long-term survival. (C) 2009 Published by Elsevier Masson SAS on behalf of the Societe francaise de radiotherapie oncologique (SFRO).