Stereotactic radiation therapy for breast cancer in the elderly

The management of breast cancer in elderly women is going to be a major public health issue in a near future. The use of hypofractionated stereotactic radiotherapy is expanding but might be a priori not offered to older patients. We addressed the role of stereotactic radiotherapy (SBRT, 1-10 fractions) in elderly patients with breast cancer, in definitive, adjuvant and metastatic settings. Review of the literature. Of six series using SBRT for partial breast or breast boost irradiation and over 20 oligometastatic (brain, lung, liver, bone) SBRT series including patients aged ≥60 years old, no difference was found in term of efficacy (>80%) and toxicity (<5% G3-4) compared to the younger. Hypofractionation is also well adapted to the elderly, due to limited transportation-related fatigue. SBRT studies by age group are lacking. However, hypofractionated SBRT is particularly adapted to older patients with breast cancer, in term of efficacy and tolerability and should be encouraged rather than more morbid treatments whenever possible.