Adjuvant treatment for older women with invasive breast cancer

Trevor A Jolly ¹, Grant R Williams ¹, Sita Bushan ², Mackenzi Pergolotti ³, Kirsten A Nyrop ¹, Ellen L Jones ⁴, Hyman B Muss ¹

Affiliations

¹ Hematology & Oncology Division, University of North Carolina, Chapel Hill, NC 27599, USA.
² Department of Medicine/School of Medicine, University of North Carolina, Chapel Hill, NC 27599, USA.
³ Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA.
⁴ Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC 27599, USA.

PMID: 26767315
87 References
3 citations

Abstract

Older women experience a large share of breast cancer incidence and death. With the projected rise in the number of older cancer patients, adjuvant chemo-, radiation and endocrine therapy management will become a key component of breast cancer treatment in older women. Many factors influence adjuvant treatment decisions including patient preferences, life expectancy and tumor biology. Geriatric assessment predicts important outcomes, identifies key deficits, and can aid in the decision making process. This review utilizes clinical vignettes to illustrate core principles in adjuvant management of breast cancer in older women and suggests an approach incorporating life expectancy and geriatric assessment.

Keywords: adjuvant chemotherapy; breast cancer; elderly; endocrine therapy; geriatric assessment; geriatric oncology; radiation.

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References
External validation of an index to predict up to 9-year mortality of community-dwelling adults aged 65 and older. Mara A Schonberg, Roger B Davis, Ellen P McCarthy, Edward R Marcantonio. J Am Geriatr Soc, 2011 Jul 30; 59(8). PMID: 21797837 Free PMC article.
Meta-analysis of breast cancer outcomes in adjuvant trials of aromatase inhibitors versus tamoxifen. Mitch Dowsett, Jack Cuzick, +16 authors, Richard Peto. less J Clin Oncol, 2009 Dec 02; 28(3). PMID: 19949017 Highly Cited.
Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. Arti Hurria, Kayo Togawa, +13 authors, William P Tew. less J Clin Oncol, 2011 Aug 04; 29(25). PMID: 21810685 Free PMC article. Highly Cited.
Randomized trial of breast irradiation schedules after lumpectomy for women with lymph node-negative breast cancer. Timothy Whelan, Robert MacKenzie, +11 authors, Barbara Szechtman. less J Natl Cancer Inst, 2002 Aug 08; 94(15). PMID: 12165639
The prevalence of potentially modifiable functional deficits and the subsequent use of occupational and physical therapy by older adults with cancer. Mackenzi Pergolotti, Allison M Deal, +2 authors, Jessica Lavery, Bryce B Reeve, Hyman B Muss. less J Geriatr Oncol, 2015 Jan 24; 6(3). PMID: 25614296 Free PMC article.
Management of elderly patients with breast cancer: updated recommendations of the International Society of Geriatric Oncology (SIOG) and European Society of Breast Cancer Specialists (EUSOMA). Laura Biganzoli, Hans Wildiers, +12 authors, Riccardo Audisio. less Lancet Oncol, 2012 Apr 04; 13(4). PMID: 22469125 Highly Cited. Review.
Toxicity of adjuvant endocrine therapy in postmenopausal breast cancer patients: a systematic review and meta-analysis. Eitan Amir, Bostjan Seruga, +2 authors, Saroj Niraula, Lindsay Carlsson, Alberto Ocaña. less J Natl Cancer Inst, 2011 Jul 12; 103(17). PMID: 21743022 Highly Cited. Systematic Review.
2006 update of recommendations for the use of white blood cell growth factors: an evidence-based clinical practice guideline. Thomas J Smith, James Khatcheressian, +19 authors, Antonio C Wolff. less J Clin Oncol, 2006 May 10; 24(19). PMID: 16682719 Highly Cited.
Fractionation sensitivity and dose response of late adverse effects in the breast after radiotherapy for early breast cancer: long-term results of a randomised trial. John Yarnold, Anita Ashton, +6 authors, Roger Owen. less Radiother Oncol, 2005 May 10; 75(1). PMID: 15878095
The UK Standardisation of Breast Radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10-year follow-up results of two randomised controlled trials. Joanne S Haviland, J Roger Owen, +14 authors, START Trialists' Group. less Lancet Oncol, 2013 Sep 24; 14(11). PMID: 24055415 Highly Cited.
Implementing a geriatric assessment in cooperative group clinical cancer trials: CALGB 360401. Arti Hurria, Constance T Cirrincione, +15 authors, Harvey Jay Cohen. less J Clin Oncol, 2011 Mar 02; 29(10). PMID: 21357782 Free PMC article. Highly Cited.
Breast-conserving surgery with or without irradiation in women aged 65 years or older with early breast cancer (PRIME II): a randomised controlled trial. Ian H Kunkler, Linda J Williams, +3 authors, PRIME II investigators. less Lancet Oncol, 2015 Feb 01; 16(3). PMID: 25637340 Highly Cited.
Survival after lumpectomy and mastectomy for early stage invasive breast cancer: the effect of age and hormone receptor status. E Shelley Hwang, Daphne Y Lichtensztajn, +2 authors, Scarlett Lin Gomez, Barbara Fowble, Christina A Clarke. less Cancer, 2013 Jan 30; 119(7). PMID: 23359049 Free PMC article.
Adjuvant trastuzumab in HER2-positive breast cancer. Dennis Slamon, Wolfgang Eiermann, +21 authors, Breast Cancer International Research Group. less N Engl J Med, 2011 Oct 14; 365(14). PMID: 21991949 Free PMC article. Highly Cited.
Use of comprehensive geriatric assessment in older cancer patients: recommendations from the task force on CGA of the International Society of Geriatric Oncology (SIOG). Martine Extermann, Matti Aapro, +9 authors, Task Force on CGA of the International Society of Geriatric Oncology. less Crit Rev Oncol Hematol, 2005 Aug 09; 55(3). PMID: 16084735 Highly Cited. Systematic Review.
Predicting 10-year mortality for older adults. Marisa Cruz, Kenneth Covinsky, +2 authors, Eric W Widera, Irena Stijacic-Cenzer, Sei J Lee. less JAMA, 2013 Mar 07; 309(9). PMID: 23462780 Free PMC article.
Physiologic aspects of aging: impact on cancer management and decision making, part II. Mary Sehl, Rishi Sawhney, Arash Naeim. Cancer J, 2006 Jan 06; 11(6). PMID: 16393480 Review.
A randomised trial of mastectomy only versus tamoxifen for treating elderly patients with operable primary breast cancer-final results at 20-year follow-up. J Chakrabarti, F S Kenny, +3 authors, K L Cheung. less Crit Rev Oncol Hematol, 2010 May 08; 78(3). PMID: 20447833
Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials. Early Breast Cancer Trialists' Collaborative Group (EBCTCG), C Davies, +11 authors, R Peto. less Lancet, 2011 Aug 02; 378(9793). PMID: 21802721 Free PMC article. Highly Cited.
Adjuvant cyclophosphamide, methotrexate, and fluorouracil in node-positive breast cancer: the results of 20 years of follow-up. G Bonadonna, P Valagussa, +2 authors, A Moliterni, M Zambetti, C Brambilla. less N Engl J Med, 1995 Apr 06; 332(14). PMID: 7877646 Highly Cited.
United States life tables, 2007. Elizabeth Arias. Natl Vital Stat Rep, 2011 Nov 11; 59(9). PMID: 22070012
Geriatric assessment-identified deficits in older cancer patients with normal performance status. Trevor A Jolly, Allison M Deal, +10 authors, Hyman B Muss. less Oncologist, 2015 Mar 15; 20(4). PMID: 25765876 Free PMC article.
Preferences for cancer treatments: an overview of methods and applications in oncology. P Blinman, M King, +2 authors, R Norman, R Viney, M R Stockler. less Ann Oncol, 2012 Jan 12; 23(5). PMID: 22234737 Review.
Prognostic indices for older adults: a systematic review. Lindsey C Yourman, Sei J Lee, +2 authors, Mara A Schonberg, Eric W Widera, Alexander K Smith. less JAMA, 2012 Jan 12; 307(2). PMID: 22235089 Free PMC article. Highly Cited. Systematic Review.
Adjuvant chemotherapy in older and younger women with lymph node-positive breast cancer. Hyman B Muss, Susan Woolf, +11 authors, Cancer and Leukemia Group B. less JAMA, 2005 Mar 03; 293(9). PMID: 15741529
Tamoxifen treatment and risk of deep venous thrombosis and pulmonary embolism: a Danish population-based cohort study. Rohini K Hernandez, Henrik Toft Sørensen, +2 authors, Lars Pedersen, Jacob Jacobsen, Timothy L Lash. less Cancer, 2009 Jul 02; 115(19). PMID: 19569248
Comprehensive Geriatric Assessment and predicted 3-year survival in treatment planning for frail patients with early breast cancer. A Stotter, M W Reed, +2 authors, L J Gray, N Moore, T G Robinson. less Br J Surg, 2015 Feb 25; 102(5). PMID: 25708660
Congestive heart failure in older women treated with adjuvant anthracycline chemotherapy for breast cancer. Mary C Pinder, Zhigang Duan, +2 authors, Sharon H Giordano. less J Clin Oncol, 2007 Aug 01; 25(25). PMID: 17664460 Highly Cited.
Primary endocrine therapy as a treatment for older women with operable breast cancer - a comparison of randomised controlled trial and cohort study findings. J L Morgan, M W Reed, L Wyld. Eur J Surg Oncol, 2014 Apr 08; 40(6). PMID: 24703110 Systematic Review.
Two months of doxorubicin-cyclophosphamide with and without interval reinduction therapy compared with 6 months of cyclophosphamide, methotrexate, and fluorouracil in positive-node breast cancer patients with tamoxifen-nonresponsive tumors: results from the National Surgical Adjuvant Breast and Bowel Project B-15. B Fisher, A M Brown, +7 authors, C G Kardinal. less J Clin Oncol, 1990 Sep 01; 8(9). PMID: 2202791 Highly Cited.
A systematic review of physicians' survival predictions in terminally ill cancer patients. Paul Glare, Kiran Virik, +4 authors, Nicholas Christakis. less BMJ, 2003 Jul 26; 327(7408). PMID: 12881260 Free PMC article. Highly Cited. Systematic Review.
Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Early Breast Cancer Trialists' Collaborative Group (EBCTCG), S Darby, +13 authors, R Peto. less Lancet, 2011 Oct 25; 378(9804). PMID: 22019144 Free PMC article. Highly Cited. Review.
Androgen receptor-positive triple negative breast cancer: a unique breast cancer subtype. Lee J McGhan, Ann E McCullough, +12 authors, Barbara A Pockaj. less Ann Surg Oncol, 2013 Sep 21; 21(2). PMID: 24046116
A randomised trial of primary tamoxifen versus mastectomy plus adjuvant tamoxifen in fit elderly women with invasive breast carcinoma of high oestrogen receptor content: long-term results at 20 years of follow-up. S J Johnston, F S Kenny, +6 authors, K L Cheung. less Ann Oncol, 2012 Feb 24; 23(9). PMID: 22357257
Comparison of breast cancer recurrence and outcome patterns between patients treated from 1986 to 1992 and from 2004 to 2008. Rachel J D Cossetti, Scott K Tyldesley, +2 authors, Caroline H Speers, Yvonne Zheng, Karen A Gelmon. less J Clin Oncol, 2014 Nov 26; 33(1). PMID: 25422485
Phase III trial comparing doxorubicin plus cyclophosphamide with docetaxel plus cyclophosphamide as adjuvant therapy for operable breast cancer. Stephen E Jones, Michael A Savin, +17 authors, Lina Asmar. less J Clin Oncol, 2006 Dec 01; 24(34). PMID: 17135639 Highly Cited.
Residual risk of breast cancer recurrence 5 years after adjuvant therapy. Abenaa M Brewster, Gabriel N Hortobagyi, +8 authors, Francisco J Esteva. less J Natl Cancer Inst, 2008 Aug 13; 100(16). PMID: 18695137 Free PMC article. Highly Cited.
Development and validation of a prognostic index for 4-year mortality in older adults. Sei J Lee, Karla Lindquist, Mark R Segal, Kenneth E Covinsky. JAMA, 2006 Feb 16; 295(7). PMID: 16478903 Highly Cited.
Geriatric assessment is associated with completion of chemotherapy, toxicity, and survival in older adults with cancer. Tanya M Wildes, Alexander P Ruwe, +5 authors, Graham A Colditz. less J Geriatr Oncol, 2013 Jun 25; 4(3). PMID: 23795224 Free PMC article.
International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer. Hans Wildiers, Pieter Heeren, +16 authors, Arti Hurria. less J Clin Oncol, 2014 Jul 30; 32(24). PMID: 25071125 Free PMC article. Highly Cited. Review.
Tumor characteristics and clinical outcome of elderly women with breast cancer. S G Diab, R M Elledge, G M Clark. J Natl Cancer Inst, 2000 Apr 06; 92(7). PMID: 10749910 Highly Cited.
Demographic differences in health preferences in the United States. Benjamin M Craig, Bryce B Reeve, +3 authors, Dennis A Revicki. less Med Care, 2014 Jan 01; 52(4). PMID: 24374420 Free PMC article.
Comprehensive geriatric assessment: a meta-analysis of controlled trials. A E Stuck, A L Siu, +2 authors, G D Wieland, J Adams, L Z Rubenstein. less Lancet, 1993 Oct 23; 342(8878). PMID: 8105269 Highly Cited.
Baseline comprehensive geriatric assessment is associated with toxicity and survival in elderly metastatic breast cancer patients receiving single-agent chemotherapy: results from the OMEGA study of the Dutch breast cancer trialists' group. M E Hamaker, C Seynaeve, +11 authors, C H Smorenburg. less Breast, 2013 Dec 10; 23(1). PMID: 24314824
Update of the Phase III trial 'GRETA' of surgery and tamoxifen versus tamoxifen alone for early breast cancer in elderly women. Giorgio Mustacchi, Alberto Scanni, +3 authors, Giulio Isola. less Future Oncol, 2014 Nov 11; 11(6). PMID: 25383659
Evolving risk of therapy-related acute myeloid leukemia following cancer chemotherapy among adults in the United States, 1975-2008. Lindsay M Morton, Graça M Dores, +5 authors, Rochelle E Curtis. less Blood, 2013 Feb 16; 121(15). PMID: 23412096 Free PMC article.
Understanding the treatment preferences of seriously ill patients. Terri R Fried, Elizabeth H Bradley, Virginia R Towle, Heather Allore. N Engl J Med, 2002 Apr 05; 346(14). PMID: 11932474 Highly Cited.
Toxicity and response criteria of the Eastern Cooperative Oncology Group. M M Oken, R H Creech, +4 authors, P P Carbone. less Am J Clin Oncol, 1982 Dec 01; 5(6). PMID: 7165009 Highly Cited.
Docetaxel With Cyclophosphamide Is Associated With an Overall Survival Benefit Compared With Doxorubicin and Cyclophosphamide: 7-Year Follow-Up of US Oncology Research Trial 9735. Stephen Jones, Frankie Ann Holmes, +17 authors, Michael A Savin. less J Clin Oncol, 2009 Feb 11; 27(8). PMID: 19204201 Highly Cited.
Long-term results of hypofractionated radiation therapy for breast cancer. Timothy J Whelan, Jean-Philippe Pignol, +12 authors, Carolyn Freeman. less N Engl J Med, 2010 Feb 12; 362(6). PMID: 20147717 Highly Cited.
Patterns of care and survival in cancer patients with cognitive impairment. Claire Robb, David Boulware, Janine Overcash, Martine Extermann. Crit Rev Oncol Hematol, 2009 Aug 28; 74(3). PMID: 19709899
Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer. Kevin S Hughes, Lauren A Schnaper, +18 authors, Eastern Cooperative Oncology Group. less N Engl J Med, 2004 Sep 03; 351(10). PMID: 15342805 Highly Cited.
Adjuvant paclitaxel and trastuzumab for node-negative, HER2-positive breast cancer. Sara M Tolaney, William T Barry, +16 authors, Eric P Winer. less N Engl J Med, 2015 Jan 08; 372(2). PMID: 25564897 Free PMC article. Highly Cited.
Gene expression and benefit of chemotherapy in women with node-negative, estrogen receptor-positive breast cancer. Soonmyung Paik, Gong Tang, +11 authors, Norman Wolmark. less J Clin Oncol, 2006 May 25; 24(23). PMID: 16720680 Highly Cited.
Adjuvant chemotherapy in older women with early-stage breast cancer. Hyman B Muss, Donald A Berry, +23 authors, CALGB Investigators. less N Engl J Med, 2009 May 15; 360(20). PMID: 19439741 Free PMC article. Highly Cited.
Mortality within 30 days of chemotherapy: a clinical governance benchmarking issue for oncology patients. M E R O'Brien, A Borthwick, +7 authors, I E Smith. less Br J Cancer, 2006 Dec 13; 95(12). PMID: 17160081 Free PMC article.
Randomized trial of letrozole following tamoxifen as extended adjuvant therapy in receptor-positive breast cancer: updated findings from NCIC CTG MA.17. Paul E Goss, James N Ingle, +15 authors, Joseph L Pater. less J Natl Cancer Inst, 2005 Sep 08; 97(17). PMID: 16145047 Highly Cited.
Lumpectomy plus tamoxifen with or without irradiation in women age 70 years or older with early breast cancer: long-term follow-up of CALGB 9343. Kevin S Hughes, Lauren A Schnaper, +8 authors, William C Wood. less J Clin Oncol, 2013 May 22; 31(19). PMID: 23690420 Free PMC article. Highly Cited.
Feasibility of geriatric assessment in community oncology clinics. Grant R Williams, Allison M Deal, +7 authors, Hyman B Muss. less J Geriatr Oncol, 2014 Apr 08; 5(3). PMID: 24703978
The UK Standardisation of Breast Radiotherapy (START) Trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. START Trialists' Group, S M Bentzen, +21 authors, J R Yarnold. less Lancet, 2008 Mar 22; 371(9618). PMID: 18355913 Free PMC article. Highly Cited.
Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial. Christina Davies, Hongchao Pan, +36 authors, Adjuvant Tamoxifen: Longer Against Shorter (ATLAS) Collaborative Group. less Lancet, 2012 Dec 12; 381(9869). PMID: 23219286 Free PMC article. Highly Cited.
Prognostic value of geriatric assessment in older patients with advanced breast cancer receiving chemotherapy. A A Aaldriks, E J Giltay, +5 authors, E Maartense. less Breast, 2013 Feb 19; 22(5). PMID: 23414850
Leukemia following breast cancer: an international population-based study of 376,825 women. Regan A Howard, Ethel S Gilbert, +9 authors, Lois B Travis. less Breast Cancer Res Treat, 2007 Jan 16; 105(3). PMID: 17221155
Breast and ovarian cancer in the older woman. William P Tew, Hyman B Muss, +2 authors, Stuart M Lichtman. less J Clin Oncol, 2014 Jul 30; 32(24). PMID: 25071129 Review.
Challenges in the treatment of older breast cancer patients. Grant R Williams, Ellen Jones, Hyman B Muss. Hematol Oncol Clin North Am, 2013 Aug 07; 27(4). PMID: 23915745 Review.
Perspectives on post-treatment cancer care: qualitative research with survivors, nurses, and physicians. Maria E Hewitt, Annette Bamundo, Rebecca Day, Catherine Harvey. J Clin Oncol, 2007 Jun 01; 25(16). PMID: 17538172
Age and clinical decision making in oncology patients. S B Yellen, D F Cella, W T Leslie. J Natl Cancer Inst, 1994 Dec 07; 86(23). PMID: 7966414
Physiologic aspects of aging: impact on cancer management and decision making, part I. Rishi Sawhney, Mary Sehl, Arash Naeim. Cancer J, 2006 Jan 06; 11(6). PMID: 16393479 Review.
Competing causes of death from a randomized trial of extended adjuvant endocrine therapy for breast cancer. Judith-Anne W Chapman, Daniel Meng, +6 authors, Paul E Goss. less J Natl Cancer Inst, 2008 Feb 14; 100(4). PMID: 18270335 Free PMC article.
Randomized trial of dose-dense versus conventionally scheduled and sequential versus concurrent combination chemotherapy as postoperative adjuvant treatment of node-positive primary breast cancer: first report of Intergroup Trial C9741/Cancer and Leukemia Group B Trial 9741. Marc L Citron, Donald A Berry, +18 authors, Larry Norton. less J Clin Oncol, 2003 Apr 02; 21(8). PMID: 12668651 Highly Cited.
Geriatric assessment predicts survival for older adults receiving induction chemotherapy for acute myelogenous leukemia. Heidi D Klepin, Ann M Geiger, +5 authors, Bayard L Powell. less Blood, 2013 Apr 04; 121(21). PMID: 23550038 Free PMC article. Highly Cited.
Studies of comprehensive geriatric assessment in patients with cancer. Martine Extermann. Cancer Control, 2003 Dec 04; 10(6). PMID: 14652522 Review.
Age-specific changes in intrinsic breast cancer subtypes: a focus on older women. Emily O Jenkins, Allison M Deal, +4 authors, Hyman B Muss. less Oncologist, 2014 Aug 22; 19(10). PMID: 25142841 Free PMC article.
Tamoxifen with or without breast irradiation in women 50 years of age or older with early breast cancer. Anthony W Fyles, David R McCready, +5 authors, Ivo A Olivotto. less N Engl J Med, 2004 Sep 03; 351(10). PMID: 15342804
The changing prevalence of comorbidity across the age spectrum. Jay F Piccirillo, Anna Vlahiotis, +3 authors, Ewout W Steyerberg. less Crit Rev Oncol Hematol, 2008 Apr 01; 67(2). PMID: 18375141 Free PMC article.
Index to predict 5-year mortality of community-dwelling adults aged 65 and older using data from the National Health Interview Survey. Mara A Schonberg, Roger B Davis, Ellen P McCarthy, Edward R Marcantonio. J Gen Intern Med, 2009 Aug 04; 24(10). PMID: 19649678 Free PMC article.
Adjuvant endocrine therapy for women with hormone receptor-positive breast cancer: american society of clinical oncology clinical practice guideline focused update. Harold J Burstein, Sarah Temin, +10 authors, Jennifer J Griggs. less J Clin Oncol, 2014 May 29; 32(21). PMID: 24868023 Free PMC article. Highly Cited.
The value of geriatric assessments in predicting treatment tolerance and all-cause mortality in older patients with cancer. Marije E Hamaker, Alinda G Vos, +2 authors, Barbara C van Munster. less Oncologist, 2012 Sep 04; 17(11). PMID: 22941970 Free PMC article. Review.
Improvement in breast cancer outcomes over time: are older women missing out? Benjamin D Smith, Jing Jiang, +4 authors, Thomas A Buchholz. less J Clin Oncol, 2011 Nov 10; 29(35). PMID: 22067407
Aromatase inhibitors in breast cancer. Ian E Smith, Mitch Dowsett. N Engl J Med, 2003 Jun 13; 348(24). PMID: 12802030 Highly Cited. Review.
Effect of radiotherapy fraction size on tumour control in patients with early-stage breast cancer after local tumour excision: long-term results of a randomised trial. J Roger Owen, Anita Ashton, +6 authors, John R Yarnold. less Lancet Oncol, 2006 Jun 06; 7(6). PMID: 16750496
Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Early Breast Cancer Trialists' Collaborative Group (EBCTCG). Lancet, 2005 May 17; 365(9472). PMID: 15894097 Highly Cited.
A randomized trial of letrozole in postmenopausal women after five years of tamoxifen therapy for early-stage breast cancer. Paul E Goss, James N Ingle, +15 authors, Joseph L Pater. less N Engl J Med, 2003 Oct 11; 349(19). PMID: 14551341 Highly Cited.
The UK Standardisation of Breast Radiotherapy (START) Trial A of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. START Trialists' Group, S M Bentzen, +20 authors, J R Yarnold. less Lancet Oncol, 2008 Mar 22; 9(4). PMID: 18356109 Free PMC article. Highly Cited.
Greater risks of chemotherapy toxicity in elderly patients with cancer. Lazzaro Repetto. J Support Oncol, 2004 Sep 07; 1(4 Suppl 2). PMID: 15346996 Review.
Surgery, with or without tamoxifen, vs tamoxifen alone for older women with operable breast cancer: cochrane review. D Hind, L Wyld, M W Reed. Br J Cancer, 2007 Feb 08; 96(7). PMID: 17285133 Free PMC article.
Predicting the risk of chemotherapy toxicity in older patients: the Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score. Martine Extermann, Ivette Boler, +8 authors, Lodovico Balducci. less Cancer, 2011 Nov 11; 118(13). PMID: 22072065 Highly Cited.

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