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Holmqvist A, Lindahl G, Mikivier R, Uppungunduri S. Age as a potential predictor of acute side effects during chemoradiotherapy in primary cervical cancer patients. BMC Cancer 2022; 22:371. [PMID: 35392858 PMCID: PMC8991473 DOI: 10.1186/s12885-022-09480-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/31/2022] [Indexed: 11/19/2022] Open
Abstract
Background Toxicity during chemoradiotherapy (CRT) in cervical cancer patients might limit the chances of receiving an optimal treatment and to be cured. Few studies have shown relationships between acute side effects and patient’s age. Here, the association between age and acute side effects such as nausea/vomiting, diarrhea and weight loss during CRT was analysed in cervical cancer patients. Methods This study included 93 patients with primary cervical cancer stage IBI to IVA who received CRT from 2013 to 2019. The frequency of symptoms/toxicity grade was analysed by using the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Results Patients ≥ 52 years had a significantly higher frequency of nausea/vomiting and increased grade ≥ 3 toxicity during CRT compared to younger patients (p < 0.001, p = 0.001). Toxicity grade ≥ 3 of nausea/vomiting was associated with increased frequency of weight loss (p = 0.001), reduced ADL (p = 0.001) and dose modifications of both radiotherapy (RT) (p = 0.020) and chemotherapy (CT) (p = 0.030) compared to toxicity grade 2. The frequency of diarrhea (p = 0.015) and weight loss (p = 0.020) was higher in older patients compared to younger. Conclusions Older patients have an increased risk of acute side effects as nausea/vomiting, diarrhea and weight loss. Age could be useful in predicting acute side effects in primary cervical cancer patients with CRT.
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Affiliation(s)
- Annica Holmqvist
- Department of health, medicine and caring siences, Linköping University, Linköping, Sweden. .,Department of Oncology, S-58185, Linköping, Sweden.
| | - Gabriel Lindahl
- Department of health, medicine and caring siences, Linköping University, Linköping, Sweden.,Department of Oncology, S-58185, Linköping, Sweden
| | - Rasmus Mikivier
- Department of health, medicine and caring siences, Linköping University, Linköping, Sweden.,Regional Cancer Centre Southeast, Linköping, Sweden
| | - Srinivas Uppungunduri
- Department of health, medicine and caring siences, Linköping University, Linköping, Sweden.,Regional Cancer Centre Southeast, Linköping, Sweden
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VanderWalde N, Moughan J, Lichtman SM, Jagsi R, Ballo M, VanderWalde A, Mohiuddin M, Meropol NJ, Kachnic L, Berger A, Ajani J, Anne R, Hopkins JL, Arora A, Meyer J, Ellsworth SG, Lee RJ, Green N, Crane CH. The association of age with acute toxicities in NRG oncology combined modality lower GI cancer trials. J Geriatr Oncol 2021; 13:294-301. [PMID: 34756496 DOI: 10.1016/j.jgo.2021.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/03/2021] [Accepted: 10/18/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Expected toxicity from chemoradiation (CRT) is an important factor in treatment decisions but is poorly understood in older adults with lower gastrointestinal (GI) malignancies. Our objective was to compare acute adverse events (AAEs) of older and younger adults with lower GI malignancies treated on NRG studies. METHODS Data from 6 NRG trials, testing combined modality therapy in patients with anal or rectal cancer, were used to test the hypothesis that older age was associated with increased AAEs. AAEs and compliance with protocol-directed therapy were compared between patients aged ≥70 and < 70. Categorical variables were compared across age groups using the chi-square test. The association of age on AAEs was evaluated using a covariate-adjusted logistic regression model, with odds ratio (OR) reported. To adjust for multiple comparisons, a p-value <0.01 was considered statistically significant. RESULTS There were 2525 patients, including 380 patients ≥70 years old (15%) evaluable. Older patients were more likely to have worse baseline performance status (PS 1 or 2) (23% vs. 16%, p = 0.001), but otherwise baseline characteristics were similar. Older patients were less likely to complete their chemotherapy (78% vs. 87%, p < 0.001), but had similar RT duration. On univariate analysis, older patients were more likely to experience grade ≥ 3 GI AAEs (36% vs. 23%, p < 0.001), and less likely to experience grade ≥ 3 skin AAEs (8% vs. 14%, p = 0.002). On multivariable analysis, older age was associated with grade ≥ 3 GI AAE (OR 1.93, 95% CI: 1.52, 2.47, p < 0.001) after adjusting for sex, race, PS, and disease site. CONCLUSIONS Older patients with lower GI cancers who underwent CRT were less likely to complete chemotherapy and had higher rates of grade 3+ GI AAEs. These results can be used to counsel older adults prior to treatment and manage expected toxicities throughout pelvic CRT.
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Affiliation(s)
- Noam VanderWalde
- University of Tennessee Health Science Center/The West Clinic - Wolf River, USA.
| | | | | | | | - Matthew Ballo
- University of Tennessee Health Science Center/The West Clinic - Wolf River, USA
| | - Ari VanderWalde
- University of Tennessee Health Science Center/The West Clinic - Wolf River, USA
| | | | - Neal J Meropol
- Flatiron Health/Case Comprehensive Cancer Center, Case Western Reserve University, USA
| | - Lisa Kachnic
- Columbia University, Herbert Irving Comprehensive Cancer Center, USA
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3
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Vitale SG, Capriglione S, Zito G, Lopez S, Gulino FA, Di Guardo F, Vitagliano A, Noventa M, La Rosa VL, Sapia F, Valenti G, Rapisarda AMC, Peterlunger I, Rossetti D, Laganà AS. Management of endometrial, ovarian and cervical cancer in the elderly: current approach to a challenging condition. Arch Gynecol Obstet 2018; 299:299-315. [PMID: 30542793 DOI: 10.1007/s00404-018-5006-z] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Gynaecological cancer management in older people represents a current challenge. Therefore, in the present paper, we aimed to gather all the evidence reported in the literature concerning gynecological cancers in the elderly, illustrating the state of art and the future perspectives. METHODS We searched MEDLINE (PubMed), EMBASE, Cochrane Central Register of Controlled Trials, IBECS, BIOSIS, Web of Science, SCOPUS and Grey literature (Google Scholar; British Library) from January 1952 to May 2017, using the terms "ovarian cancer", "endometrial cancer", "cervical cancer", "gynecological cancers" combined with 'elderly', 'cancer', 'clinical trial' and 'geriatric assessment'. RESULTS The search identified 81 citations, of which 65 were potentially relevant after initial evaluation and met the criteria for inclusion and were analyzed. We divided all included studies into three different issue: "Endometrial cancer", "Ovarian cancer" and "Cervical cancer". CONCLUSIONS The present literature review shows that, in spite of the higher burden of comorbidities, elderly patients can also benefit from standard treatment to manage their gynecological cancers. It is important to overcome the common habit of undertreating the elderly patients because they are more fragile and with a lower life expectancy than their younger counterpart. Further trials with elderly women are warranted.
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Affiliation(s)
- Salvatore Giovanni Vitale
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Stella Capriglione
- Department of Obstetrics and Gynecology, Istituto per la Sicurezza Sociale, 47893, Cailungo-Borgo Maggiore, Republic of San Marino.
| | - Gabriella Zito
- Department of Obstetrics and Gynecology, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Via dell'Istria 65/1, 34137, Trieste, Italy
| | - Salvatore Lopez
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, 06520, USA.,Department of Experimental and Clinical Medicine, Magna Graecia University, 88100, Catanzaro, Italy
| | | | - Federica Di Guardo
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Via Tindaro 2, 95124, Catania, Italy
| | - Amerigo Vitagliano
- Department of Woman and Child Health, University of Padua, Via Giustiniani 3, 35128, Padua, Italy
| | - Marco Noventa
- Department of Woman and Child Health, University of Padua, Via Giustiniani 3, 35128, Padua, Italy
| | - Valentina Lucia La Rosa
- Unit of Psychodiagnostics and Clinical Psychology, University of Catania, Via Santa Sofia 78, 95124, Catania, Italy
| | - Fabrizio Sapia
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Via Santa Sofia 78, 95124, Catania, Italy
| | - Gaetano Valenti
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Via Santa Sofia 78, 95124, Catania, Italy
| | - Agnese Maria Chiara Rapisarda
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Via Santa Sofia 78, 95124, Catania, Italy
| | - Isabel Peterlunger
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149, Trieste, Italy
| | - Diego Rossetti
- Unit of Gynecology and Obstetrics, Desenzano del Garda Hospital, Section of Gavardo, Via A. Gosa 74, 25085, Gavardo, Brescia, Italy
| | - Antonio Simone Laganà
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
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4
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Increasing age predicts poor cervical cancer prognosis with subsequent effect on treatment and overall survival. Brachytherapy 2018; 18:29-37. [PMID: 30361045 DOI: 10.1016/j.brachy.2018.08.016] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 07/24/2018] [Accepted: 08/24/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE Stage and histology are well-established prognostic factors for cervical cancer, but the importance of age has been controversial and a clear role for this factor has not yet been defined. Thus, we aim with this study to evaluate the significance of age as an independent prognostic factor in women with cervical cancer and evaluate the therapeutic consequences and survival outcomes as they relate to this factor. METHODS AND MATERIALS The Surveillance, Epidemiology, and End Results (SEER) database was used to retrospectively analyze patients diagnosed with cervical cancer from 1973 to 2013 in the United States. Data collected included demographics, tumor histology and stage, treatment details, and survival outcomes. Age was grouped into 20-49, 50-69, ≥70 years. Stage was localized (FIGO IA-IB1), regional (IB2-IVA), and distant (IVB). Treatments were classified as "aggressive" (surgery, external beam radiation therapy [XRT] + brachytherapy [BT], surgery + BT, surgery + XRT, or surgery + XRT + BT) or "nonaggressive" (XRT alone, BT alone, or no treatment). Statistical analysis performed on these data included the use of the Log-Rank test, χ2 analysis, and the Cox proportional hazards model. RESULTS Forty-six thousand three hundred fifty women with cervical cancer were identified using the SEER database. 54% were aged <50 years, 33% 50-69 years, and 13% ≥70 years. Older women, particular those over age 70 years, show significantly decreased survival trends when stratified by stage and histology (p < 0.0001). Furthermore, taking stage, histology, race, and treatment into account, increasing age demonstrates negative prognostic significance with a hazard ratio of 2.87 for women over age 70 years and 1.46 for women aged 50-69 years. In addition, women over 70 years, regardless of stage, are significantly more likely to receive nonaggressive treatment regimens (<0.0001), or no treatment at all (p < 0.0001). Finally, older women gain a significant survival advantage from treatment, even with less-aggressive regimens, as compared with no treatment at all (p < 0.0001), with BT alone showing the greatest survival benefit (p < 0.0001 vs no treatment; p < 0.0087 vs XRT) among less-aggressive therapies. When evaluated by stage, BT continues to hold a significant survival advantage for localized, regional, and distant disease in individuals over age 70 years (localized: p = 0.0009 vs no treatment; regional and distant: p < 0.0001 vs no treatment), with both an overall survival and disease-specific survival benefit over XRT seen as well for women with distant disease (p < 0.0001). CONCLUSIONS Older women with cervical cancer show a poor overall survival trend that remains consistent among various stages and histologic subtypes. Risk analysis of this study population supports that age is an independent negative prognostic factor, even when accounting for stage, histology, and race. Furthermore, older women receive less-aggressive treatment as compared with their younger counterparts, with a significant number receiving no treatment at all. Despite this, older women still obtain a significant survival benefit with less-aggressive therapies, particularly with BT alone. Most interesting is that BT shows a survival benefit for older women among all cervical cancer stages, supporting the immense potential clinical benefit. In fact, women over 70 years with more advanced stage disease showed a significant survival benefit, both overall survival and disease-specific survival, with BT over external beam radiotherapy as well. Previous studies have created a foundation of literature, which shows that inclusion of BT in treatment regimens among all age groups improves survival and that older women in general are less likely to be adequately treated for cervical cancer. The novelty of this study lies in the fact that it demonstrates that older women, who we show are at risk for a poorer overall prognosis because of their age, are not only receiving appropriate treatment less often, they are also dying more frequently because of it. Our data support that older women are a high-risk group of patients who would benefit significantly from treatment, even if that treatment is BT alone. BT for cervical cancer is a tolerable procedure, even for most elderly women, and should, therefore, remain a standard clinical option for this population, regardless of their stage or histology at diagnosis.
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5
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Goineau A, Campion L, d’Aillières B, Vié B, Ghesquière A, Béra G, Jaffres D, de Laroche G, Magné N, Artignan X, Chamois J, Bergerot P, Martin E, Créhange G, Deniaud-Alexandre E, Buthaud X, Belkacémi Y, Doré M, de Decker L, Supiot S. Comprehensive Geriatric Assessment and quality of life after localized prostate cancer radiotherapy in elderly patients. PLoS One 2018; 13:e0194173. [PMID: 29630602 PMCID: PMC5890970 DOI: 10.1371/journal.pone.0194173] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 02/26/2018] [Indexed: 02/07/2023] Open
Abstract
Introduction Radiotherapy can diminish quality of life (QoL) for prostate cancer patients. Our objective was to evaluate the effect of radiotherapy on QoL in men aged 75 years or older treated with radiotherapy for a localized prostate cancer, and to identify predictors of reduced QoL. Patients and methods We prospectively administered a battery of geriatric (MNA, GDS, Get up and Go Test, CIRS-G, ADL, IADL, MMSE), toxicity (IPSS; IIEF 5), and QoL (QLQ C30) screening tests in 100 elderly patients before and two months after prostate cancer radiotherapy (NCT 02876237). Patients ≥ 75 years undergoing radiotherapy with a curative intent for localized prostate cancer with or without androgen deprivation therapy (ADL) were eligible for study inclusion. Correlations between patient-assessed QoL and tumor characteristics, radiotherapy treatment or CGA parameters were sought using the Fisher or the Mann and Whitney tests. Changes in QoL parameters over time were analyzed using the Wilcoxon signed-rank test. Results At study entry, scores for IADL impairments were present in 51%, reduced autonomy in activities of daily living in 16%, cognitive impairment found in 20%, depression-related symptoms in 31%, and 66% of patients had significant co-morbidities. Eight percent were judged to be at risk of fall and 2% were found to be undernourished. Severely impaired (IPSS ≥ 20) urinary function was observed in 11.2% and 13.5% of patients before and two months after completion of radiotherapy respectively. Significantly decreased QoL (> 20 points) at two months after treatment was found in 13% of patients and a moderate but clinically relevant reduction (10 to 20 points) in 17% of patients. No tumor characteristic, treatment, or oncogeriatric parameter was predictive of reduced QoL following prostate cancer radiotherapy. Conclusion Despite sometimes markedly diminished oncogeriatric parameters, prostate cancer radiotherapy was generally well tolerated in these elderly patients. We found no predictive factor to determine which patients would experience impaired quality of life following radiotherapy.
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Affiliation(s)
- Aurore Goineau
- Department of Radiation Oncology, Institut de Cancérologie de l’Ouest, Angers, France
- * E-mail:
| | - Loïc Campion
- Department of Statistics, Institut de Cancérologie de l’Ouest, Saint Herblain, France
| | - Bénédicte d’Aillières
- Department of Radiation Oncology, Institut de Cancérologie de l’Ouest, Angers, France
| | - Brigitte Vié
- Department of Radiation Oncology, Clinique Armoricaine de Radiologie, St Brieuc, France
| | - Agnès Ghesquière
- Department of Radiation Oncology, Clinique Armoricaine de Radiologie, St Brieuc, France
| | - Guillaume Béra
- Department of Radiation Oncology, Centre Hospitalier de Bretagne Sud, Lorient, France
| | - Didier Jaffres
- Department of Radiation Oncology, Centre Hospitalier de Bretagne Sud, Lorient, France
| | - Guy de Laroche
- Department of Radiation Oncology, Institut de Cancérologie de Loire, St Priest en Jarez, France
| | - Nicolas Magné
- Department of Radiation Oncology, Institut de Cancérologie de Loire, St Priest en Jarez, France
| | - Xavier Artignan
- Department of Radiation Oncology, CHP St Grégoire, St Grégoire, France
| | - Jérôme Chamois
- Department of Radiation Oncology, CHP St Grégoire, St Grégoire, France
| | - Philippe Bergerot
- Department of Radiation Oncology, Clinique Mutualiste de l’Estuaire, St Nazaire, France
| | - Etienne Martin
- Department of Radiation Oncology, Centre Georges François Leclerc, Dijon, France
| | - Gilles Créhange
- Department of Radiation Oncology, Centre Georges François Leclerc, Dijon, France
| | | | - Xavier Buthaud
- Department of Radiation Oncology, Centre Catherine de Sienne, Nantes, France
| | - Yazid Belkacémi
- Department of Radiation Oncology, CHU Henri Mondor, Créteil, France
| | - Mélanie Doré
- Department of Radiation Oncology, Institut de Cancérologie de l’Ouest, Saint Herblain, France
| | - Laure de Decker
- Department of Radiation Oncology, Institut de Cancérologie de l’Ouest, Saint Herblain, France
| | - Stéphane Supiot
- Department of Radiation Oncology, Institut de Cancérologie de l’Ouest, Saint Herblain, France
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6
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Management of elderly women with cervical cancer. J Cancer Res Clin Oncol 2018; 144:961-967. [PMID: 29500704 DOI: 10.1007/s00432-018-2617-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 02/20/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Elderly women with cervical cancer receive less therapy in comparison with their younger counterparts. The exact reason(s) for this treatment strategy remains unclear. PATIENTS AND METHODS We performed a multicenter, retrospective registry-based study of 1559 patients with cervical cancer. The primary outcome was the reason for not performing the indicated treatment. RESULTS Median follow-up was 67.8 months. A total of 956 women were eligible for analysis: 693 (64.2%) were younger than 60 years and 387 (35.8%) were aged 61 years old and older. Elderly women were more likely to have undifferentiated cervical cancer at an advanced stage. For early stage (stage IA1-IIA), tumors patients 61 years old and older were less likely to receive surgery [odds ratio (OR) 0.39; 95% CI 0.20-0.77] and radiochemotherapy (OR 0.37; 95% CI 0.21-0.66) compared with the group of patients aged < 60 years. The rate of lymphadenectomy was similar in both age groups. Patients 61 years old and older with advanced stage (IIB-IV) cervical cancer were also less likely to receive surgery [odds ratio (OR) 0.42; 95% CI 0.27-0.66], lymphadenectomy (OR 0.30; 95% CI 0.12-0.51) and radiochemotherapy (OR 0.31; 95% CI 0.20-0.48) compared with patients aged < 60 years. Notably, the rate of indicated but not performed therapies proportionally increased with an increase in patient age and the most important reason for this phenomenon was the failing of recommendation. CONCLUSIONS Elderly women with cervical cancer are undertreated and this is more likely because the therapy was not recommended.
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Park JH, Kim YS, Ahn SD, Choi EK, Shin SS, Kim YT, Kim YM, Kim JH, Yi SY, Nam JH. Concurrent Chemoradiotherapy or Radiotherapy Alone for Locally Advanced Cervical Cancer in Elderly Women. TUMORI JOURNAL 2018. [DOI: 10.1177/548.6516] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background To evaluate the efficacy and toxicity of concurrent chemoradiotherapy or radiotherapy alone in elderly patients with locally advanced cervical carcinoma (stage IB2-IVA). Methods and study design We retrospectively reviewed the medical records of 105 women aged ≥65 years who received radiotherapy (group I, n = 61) or concurrent chemoradiotherapy (group II, n = 44). Patients received a median dose of 76.4 Gy to point A, including 30-35 Gy of high-dose intracavity brachytherapy. The concurrent chemoradiotherapy group received platinum-based chemotherapy. Results The median follow-up was 65 months for surviving patients. There was no significant difference in compliance to radiotherapy between the two groups. Most acute toxicities were hematologic; acute hematologic and gastrointestinal toxicity were significantly more common in group II. Five-year overall survival and cancer-specific survival rates were, respectively, 53.5% and 66.6% in group I and 61.8% and 68.8% in group II. Performance status, comorbidity index, tumor size, and stage were independent prognostic factors for overall survival, whereas stage was the only prognostic factor for cancer-specific survival. Conclusions The analysis showed no benefit of concurrent chemoradiotherapy with respect to overall survival and cancer-specific survival in elderly women. A prospective study is needed to determine the role of concurrent chemoradiotherapy in this population. Free full text available at www.tumorionline.it
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Affiliation(s)
- Jin-hong Park
- Departments of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul
| | - Young Seok Kim
- Departments of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul
| | - Seung Do Ahn
- Departments of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul
| | - Eun Kyung Choi
- Departments of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul
| | - Seong Soo Shin
- Departments of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul
| | - Young-Tak Kim
- Departments of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul
| | - Yong-Man Kim
- Departments of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul
| | - Jong-Hyeok Kim
- Departments of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul
| | - Seong Yoon Yi
- Division of Hematology-Oncology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Seoul, Korea
| | - Joo-Hyun Nam
- Departments of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul
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8
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Cèfaro GA, Genovesi D, Vinciguerra A, Augurio A, Di Tommaso M, Marchese R, Borzillo V, Tasciotti L, Taraborrelli M, Innocenti P, Colecchia G, Di Nicola M. Effects of Preoperative Radiochemotherapy with Capecitabine for Resectable Locally Advanced Rectal Cancer in Elderly Patients. TUMORI JOURNAL 2018; 98:622-9. [DOI: 10.1177/030089161209800513] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Aims and background Rectal cancer is a common disease of elderly people. However, patients over 70 years of age are often not included in clinical trials. There is a lack of data concerning the use of radiochemotherapy with capecitabine in elderly patients. The aim of this study was to retrospectively evaluate the impact of preoperative radiochemotherapy with capecitabine on downstaging and sphincter preservation and to assess treatment compliance and toxicity in elderly patients. Methods Twenty-six patients with resectable locally advanced rectal cancer (stage II-III/TNM) aged >70 years received preoperative radiotherapy and concurrent oral capecitabine 825 mg/m2 twice daily during the whole period of radiotherapy. Two patients who refused surgery after chemoradiation therapy were excluded from the analysis. Results Eighty-one percent of patients underwent anterior resection and 18.1% underwent abdominoperineal resection. Overall tumor downstaging, considering both T and N categories, was observed in 18/24 patients (75%). Treatment compliance was good and toxicity rates were similar to those of younger people. Conclusions Age is not a contraindication to any therapy and elderly patients who can tolerate radiochemotherapy should be treated like younger patients. Preoperative radiochemotherapy with capecitabine for patients aged >70 years has a good impact on tumor downstaging, increases the feasibility of sphincter-preserving surgery, and is also safe and well tolerated.
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Affiliation(s)
| | - Domenico Genovesi
- Radiation Oncology Department, G d'Annunzio University, Chieti, Italy
| | | | | | - Monica Di Tommaso
- Radiation Oncology Department, G d'Annunzio University, Chieti, Italy
| | - Rita Marchese
- Radiation Oncology Department, G d'Annunzio University, Chieti, Italy
| | | | - Lucia Tasciotti
- Radiation Oncology Department, G d'Annunzio University, Chieti, Italy
| | | | - Paolo Innocenti
- Surgery Department, G. d'Annunzio University, Chieti, G d'Annunzio University, Chieti, Italy
| | - Giuseppe Colecchia
- Surgery Department, Santo Spirito Hospital, Pescara, G d'Annunzio University, Chieti, Italy
| | - Marta Di Nicola
- Laboratory of Biostatistics, Department of Biomedical Science, G d'Annunzio University, Chieti, Italy
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9
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Moore KN, Java JJ, Slaughter KN, Rose PG, Lanciano R, DiSilvestro PA, Thigpen JT, Lee YC, Tewari KS, Chino J, Seward SM, Miller DS, Salani R, Moore DH, Stehman FB. Is age a prognostic biomarker for survival among women with locally advanced cervical cancer treated with chemoradiation? An NRG Oncology/Gynecologic Oncology Group ancillary data analysis. Gynecol Oncol 2016; 143:294-301. [PMID: 27542967 PMCID: PMC5693242 DOI: 10.1016/j.ygyno.2016.08.317] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 08/10/2016] [Accepted: 08/13/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the effect of age on completion of and toxicities following treatment of local regionally advanced cervical cancer (LACC) on Gynecologic Oncology Group (GOG) Phase I-III trials. METHODS An ancillary data analysis of GOG protocols 113, 120, 165, 219 data was performed. Wilcoxon, Pearson, and Kruskal-Wallis tests were used for univariate and multivariate analysis. Log rank tests were used to compare survival lengths. RESULTS One-thousand-three-hundred-nineteen women were included; 60.7% were Caucasian, 15% were age 60-70years and an additional 5% were >70; 87% had squamous histology, 55% had stage IIB disease and 34% had IIIB disease. Performance status declined with age (p=0.006). Histology and tumor stage did not significantly differ. Number of cycles of chemotherapy received, radiation treatment time, nor dose modifications varied with age. Notably, radiation protocol deviations and failure to complete brachytherapy (BT) did increase with age (p=0.022 and p<0.001 respectively). Only all grade lymphatic (p=0.006) and grade≥3 cardiovascular toxicities (p=0.019) were found to vary with age. A 2% increase in the risk of death for every year increase >50 for all-cause mortality (HR 1.02; 95% CI, 1.01-1.04) was found, but no association between age and disease specific mortality was found. CONCLUSION This represents a large analysis of patients treated for LACC with chemo/radiation, approximately 20% of whom were >60years of age. Older patients, had higher rates of incomplete brachytherapy which is not explained by collected toxicity data. Age did not adversely impact completion of chemotherapy and radiation or toxicities.
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Affiliation(s)
- Kathleen N Moore
- Division of Gynecologic Oncology, Stephenson Oklahoma Cancer Center at the University of Oklahoma, 800 NE 10th Street, Oklahoma City, OK 73121, United States.
| | - James J Java
- NRG Oncology Statistics & Data Management Center, Roswell Park Cancer Institute, Buffalo, NY 14263, United States.
| | - Katrina N Slaughter
- Division of Gynecologic Oncology, Ochsner Medical Center, 1514 Jefferson Hwy, New Orleans, LA 70121, United States.
| | - Peter G Rose
- Division of Gynecologic Oncology, Cleveland Clinic Foundation, Cleveland, OH 44109, United States.
| | - Rachelle Lanciano
- Dept. of Radiation Oncology, Crozer Keystone Regional Cancer Center at Broomall, Crozer Keystone Health System, Broomall, PA 19008, United States.
| | - Paul A DiSilvestro
- Division of Gynecologic Oncology, Women & Infants Hospital, Providence, RI 02905, United States.
| | - J Tate Thigpen
- Division of Medical Oncology, University of Mississippi Medical Center, Jackson, MS 39216, United States.
| | - Yi-Chun Lee
- Division of Gynecologic Oncology, State University of New York Downstate, Brooklyn, NY 11203, United States.
| | - Krishnansu S Tewari
- Division of Gynecologic Oncology, University of California at Irvine, Orange, CA 92868, United States.
| | - Junzo Chino
- Radiation Oncology, Duke University Medical Center, Durham, NC 27710, United States.
| | - Shelly M Seward
- Division of Gynecologic Oncology, Wayne State University/Karmanos Cancer Center, Detroit, MI 48201, United States.
| | - David S Miller
- Division of Gynecologic Oncology, UT Southwestern Medical Center at Dallas, Dallas, TX 75390, United States.
| | - Ritu Salani
- Division of Gynecologic Oncology, Ohio State University Medical Center, Columbus, OH 43210, United States.
| | - David H Moore
- Division of Obstetrics & Gynecology, Franciscan St. Francis Health, Indianapolis, IN 46237, United States.
| | - Frederick B Stehman
- Division of Gynecologic Oncology, Indiana University School of Medicine, Mel and Bren Simon Cancer Center, Indianapolis, IN 46202, United States.
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Méry B, Vallard A, Espenel S, Badie N, Thiermant M, Lambert V, Soulier V, Piqueres S, Del Santo K, Ben Mrad M, Wang G, Diao P, Langrand-Escure J, Rivoirard R, Guy JB, Guillot A, Chanelière AF, Gonthier R, Achour E, Fournel P, Magné N. Cancer de prostate des sujets âgés : place et rôle de l’évaluation gériatrique. Prog Urol 2016; 26:524-31. [DOI: 10.1016/j.purol.2016.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 06/13/2016] [Accepted: 07/22/2016] [Indexed: 11/30/2022]
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11
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[Radiation therapy for elderly patients]. Cancer Radiother 2015; 19:391-6. [PMID: 26344439 DOI: 10.1016/j.canrad.2015.05.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 05/22/2015] [Accepted: 05/29/2015] [Indexed: 11/21/2022]
Abstract
Cancer is a disease that predominantly occurs in older patients who represent a quarter of the population in western countries. Numerous types of cancer are observed in elderly people. Radiotherapy is one of the most powerful treatments against cancer. Most of published studies have demonstrated feasibility of radiotherapy in curative or palliative intent whatever cancer types are considered. Complete geriatric assessment and a multidisciplinary approach are the key points. The purpose of this review is to highlight sights of radiation oncology specifically related to aging. Particular emphasis is placed on logistic and technical aspects of radiation, as dose, irradiated volume, fractionation and the potential usefulness of new technologies.
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Moye VA, Chandramouleeswaran S, Zhao N, Muss HB, Weissler MC, Hayes DN, Zevallos JP. Elderly patients with squamous cell carcinoma of the head and neck and the benefit of multimodality therapy. Oncologist 2015; 20:159-65. [PMID: 25582139 DOI: 10.1634/theoncologist.2013-0325] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Limited data are available regarding outcomes in elderly head and neck cancer patients. This retrospective study was designed to characterize head and neck cancer in geriatric patients. PATIENTS AND METHODS This study included all patients in a large university-based tumor registry who were diagnosed with head and neck cancer from January 1, 1990, to December 31, 2005. Patients aged ≥70 years at the time of diagnosis were defined as older. Overall survival and progression-free survival were censored at 60 months. Survival differences were compared using the log-rank test. Hazard ratios were estimated using a Cox proportional hazards model, adjusting for potential confounders. RESULTS Of 1,598 patients identified, 1,166 patients were aged <70 years (i.e., younger) and 281 patients were aged ≥70 years (older). When controlling for possible confounders, older patients were nearly twice as likely to die within 5 years as their younger counterparts (hazard ratio: 1.92). The median life expectancy for older patients was nearly 5 years for stage I-II disease and <2 years for stage III-IV disease. Older patients with stage III-IV disease who received multimodality therapy had 5-year survival similar to that younger patients with stage III-IV disease who were treated similarly (33.2% vs. 44.0%). Older patients with stage III-IV disease who received single-modality therapy had extremely poor survival compared with all other patients (hazard ratio for progression-free survival: 1.5). CONCLUSION This study highlights the need for better understanding of the factors affecting head and neck cancer outcomes in elderly patients. Information about life expectancy in elderly head and neck cancer patients may help guide treatment decisions.
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Affiliation(s)
- Virginia A Moye
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA; UNC Lineberger Comprehensive Cancer Center and Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sindhu Chandramouleeswaran
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA; UNC Lineberger Comprehensive Cancer Center and Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ni Zhao
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA; UNC Lineberger Comprehensive Cancer Center and Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Hyman B Muss
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA; UNC Lineberger Comprehensive Cancer Center and Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Mark C Weissler
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA; UNC Lineberger Comprehensive Cancer Center and Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - David N Hayes
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA; UNC Lineberger Comprehensive Cancer Center and Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jose P Zevallos
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA; UNC Lineberger Comprehensive Cancer Center and Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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13
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George EM, Tergas AI, Ananth CV, Burke WM, Lewin SN, Prendergast E, Neugut AI, Hershman DL, Wright JD. Safety and tolerance of radical hysterectomy for cervical cancer in the elderly. Gynecol Oncol 2014; 134:36-41. [PMID: 24768851 PMCID: PMC4158005 DOI: 10.1016/j.ygyno.2014.04.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 04/06/2014] [Accepted: 04/14/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Despite institutional studies that suggest that radical hysterectomy for cervical cancer is well tolerated in the elderly, little population-level data are available on the procedure's outcomes in older women. We performed a population-based analysis to determine the morbidity, mortality, and resource utilization of radical hysterectomy in elderly women with cervical cancer. METHODS Patients recorded in the Nationwide Inpatient Sample with invasive cervical cancer who underwent abdominal radical hysterectomy between 1998 and 2010 were analyzed. Patients were stratified by age: <50, 50-59, 60-69, and ≥70 years. We examined the association between age and the outcomes of interest using chi square tests and multivariable generalized estimating equations. RESULTS A total of 8199 women were identified, including 768 (9.4%) women age 60-69 and 462 (5.6%) women ≥70 years of age. All cause morbidity increased from 22.1% in women <50, to 24.7% in those 50-59 years, 31.4% in patients 60-69 years and 34.9% in women >70years of age (P<0.0001). Compared to women<50, those >70 were more likely to have intraoperative complications (4.8% vs. 9.1%, P=0.0003), surgical site complications (10.9% vs. 17.5%, P<0.0001), and medical complications (9.9% vs. 19.5%, P<0.0001). The risk of non-routine discharge (to a nursing facility) was 0.5% in women <50 vs. 12.3% in women ≥70 (P<0.0001). Perioperative mortality women ≥70 years of age was 30 times greater than that of women <50 (P<0.0001). CONCLUSION Perioperative morbidity and mortality are substantially greater in elderly women who undergo radical hysterectomy for cervical cancer. Non-surgical treatments should be considered in these patients.
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Affiliation(s)
- Erin M George
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons
| | - Ana I Tergas
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons; Department of Epidemiology, Mailman School of Public Health, Columbia University; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons
| | - Cande V Ananth
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons; Department of Epidemiology, Mailman School of Public Health, Columbia University
| | - William M Burke
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons
| | - Sharyn N Lewin
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons
| | - Eri Prendergast
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons
| | - Alfred I Neugut
- Department of Medicine, Columbia University College of Physicians and Surgeons; Department of Epidemiology, Mailman School of Public Health, Columbia University; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons
| | - Dawn L Hershman
- Department of Medicine, Columbia University College of Physicians and Surgeons; Department of Epidemiology, Mailman School of Public Health, Columbia University; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons
| | - Jason D Wright
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons; Department of Epidemiology, Mailman School of Public Health, Columbia University; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons.
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14
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Le Fur E, Chatellier G, Berger A, Emile JF, Dousset B, Nordlinger B, Berges O, Deberne M, Dessard-Diana B, Henni M, Giraud P, Housset M, Durdux C. [Tolerance and efficacy of preoperative radiation therapy for elderly patients treated for rectal cancer]. Cancer Radiother 2013; 17:202-7. [PMID: 23643361 DOI: 10.1016/j.canrad.2013.01.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Revised: 12/22/2012] [Accepted: 01/31/2013] [Indexed: 01/09/2023]
Abstract
PURPOSE To retrospectively assess the impact of age on tolerance and oncologic outcomes treated by neoadjuvant treatment for patients of 70 years old or above with locally advanced rectal cancer. PATIENTS AND METHODS Ninety-one consecutive patients were divided into three groups: group 1 from 70 to 75 years (n=31); group 2: 76 to 79 years (n=31) and group 3, patients aged 80 years or above (n=29). Radiation therapy was delivered according two schemes: 25Gy in five fractions (short scheme) or 45 to 50Gy with a classical fractionation (long scheme). Long scheme patients received a concomitant chemotherapy with 5-fluoro-uracile alone or associated with oxaliplatin. RESULTS The three groups were comparable for performance status, Charlson's score and T staging. Long scheme radiation therapy and chemotherapy were performed in 77.5, 74.5 and 48.3% of patients (P=0.03) and 77.4, 71 and 41.4% (P=0.006) in the groups 1, 2 and 3, respectively. All patients treated with the short scheme irradiation received the treatment without any acute toxicity. In the long scheme group, 65% of patients received the treatment on time and grade 3 or above toxicity was observed in 12% of patients who did not receive oxaliplatin and in 48% of patients who received oxaliplatin. The overall survival rate at 3 and 5 years was 66.9% and 60.8% in the group 1, 90.5% and 75.9% in the group 2 and 80.5% and 73.8% in the group 3 (P=0.15). CONCLUSION Neoadjuvant treatment is feasible with encouraging survival rates for patients aged 70 years and older. Short scheme radiation therapy seems to be an interesting option in this population.
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Affiliation(s)
- E Le Fur
- Service de radiothérapie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
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Colorectal Cancer in the Elderly: How Do We Tailor Treatment with Chemotherapy and Radiotherapy Most Appropriately? CURRENT COLORECTAL CANCER REPORTS 2013. [DOI: 10.1007/s11888-013-0163-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Yucel B, Okur Y, Akkas EA, Eren MF. Lack of Impact of Age on Acute Side Effects and Tolerance of Curative Radiation Therapy. Asian Pac J Cancer Prev 2013. [DOI: 10.7314/apjcp.2013.14.2.969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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17
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Ouldamer L, Duquesne M, Arbion F, Barillot I, Marret H, Body G. Impact de la prise en charge thérapeutique sur la survie chez les femmes très âgées avec cancer de l’endomètre. ACTA ACUST UNITED AC 2012; 40:759-64. [DOI: 10.1016/j.gyobfe.2012.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Accepted: 06/12/2012] [Indexed: 10/27/2022]
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Abstract
Colorectal cancer (CRC) largely affects older individuals; almost half of cases occur in patients >75 years old. The incidence increases with advancing age, doubling every 7 years in patients aged ≥50 years. The medical and societal burdens of CRC will probably worsen over the coming decades as the number of older individuals (>70) continues to grow. No evidence-based guidelines are available for this age group, as older patients with CRC are generally excluded from randomized clinical trials and the fit ones who are recruited are not representative of the general elderly population. When feasible, surgery is the most successful treatment option for eradicating the primary lesion, as well as any metastases. The operative risk under elective conditions is not markedly different in older than in younger patients; however, the acute setting is to be avoided as it is associated with high operative death rates. Well-selected older patients can tolerate chemotherapy, but benefits need to be balanced against potentially limited life expectancy and reduced quality of life. The use of combination chemotherapy is an area of much controversy, but this treatment should not necessarily be withheld because of the age of the patient. Careful monitoring of toxicities and early intervention is essential in older patients undergoing chemotherapy.
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Affiliation(s)
- Riccardo A Audisio
- University of Liverpool, St Helens Teaching Hospital, Department of Surgery, Marshalls Cross Road, St Helens, Liverpool WA9 3DA, UK.
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Desbat NHH, Levy A, Auberdiac P, Moncharmont C, Oriol M, Malkoun N, Tinquaut F, Bourmaud A, Chargari C, Merrouche Y, de Laroche G, Magné N. Curative-Intended Treatment of Squamous Cell Anal Carcinoma in Elderly Adults. J Am Geriatr Soc 2012; 60:1993-4. [DOI: 10.1111/j.1532-5415.2012.04185.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Antonin Levy
- Department of Radiation Oncology; Institut Gustave Roussy; Villejuif; France
| | - Pierre Auberdiac
- Department of Radiotherapy; Institut de Cancérologie de la Loire; Saint Priest en Jarez; France
| | - Coralie Moncharmont
- Department of Radiotherapy; Institut de Cancérologie de la Loire; Saint Priest en Jarez; France
| | - Mathieu Oriol
- Department of Public Health; Institut de Cancérologie de la Loire; Saint Priest en Jarez; France
| | - Nadia Malkoun
- Department of Radiotherapy; Institut de Cancérologie de la Loire; Saint Priest en Jarez; France
| | - Fabien Tinquaut
- Department of Medical Oncology; Institut de Cancérologie de la Loire; Saint Priest en Jarez; France
| | - Aurélie Bourmaud
- Department of Medical Oncology; Institut de Cancérologie de la Loire; Saint Priest en Jarez; France
| | - Cyrus Chargari
- Department of Radiation Oncology; HIA du Val de Grâce; Paris; France
| | - Yacine Merrouche
- Department of Medical Oncology; Institut de Cancérologie de la Loire; Saint Priest en Jarez; France
| | - Guy de Laroche
- Department of Radiotherapy; Institut de Cancérologie de la Loire; Saint Priest en Jarez; France
| | - Nicolas Magné
- Department of Radiotherapy; Institut de Cancérologie de la Loire; Saint Priest en Jarez; France
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Safety and outcome of chemoradiotherapy in elderly patients with rectal cancer: results from two French tertiary centres. Dig Liver Dis 2012; 44:350-4. [PMID: 22119617 DOI: 10.1016/j.dld.2011.10.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2011] [Revised: 10/17/2011] [Accepted: 10/20/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND The risks of chemoradiotherapy in elderly patients with rectal cancer have not yet been well-characterised. METHODS We retrospectively reviewed the charts of patients with rectal cancer over 70 years old who were treated with chemoradiotherapy in two French university hospitals. RESULTS A total of 125 patients were evaluated. Mean age was 75.1 ± 4.1 years and ranged from 70 to 90 years. Adverse effects ≥ grade 2 were observed in 32% of the patients and adverse effects ≥ grade 3 in 15%. Dose reduction for toxicity was performed in 18% of the patients and chemoradiotherapy discontinuation was necessary in 9%. Postoperative morbidity was 16% with two treatment-related deaths. Two-year survival rate was 84%. No variables had any influence on treatment-related adverse events. CONCLUSIONS In selected elderly patients, chemoradiotherapy is well-tolerated, without any significant increase in adverse events, and the results are similar to those recorded in younger patients.
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De Bari B, Lestrade L, Chekrine T, Shakir Shakir I, Ardiet JM, Chapet O, Mornex F. Faut-il adapter le traitement du carcinome du canal anal pour les patients âgés ? Analyse rétrospective de la toxicité dans un centre français et revue de la littérature. Cancer Radiother 2012; 16:52-7. [DOI: 10.1016/j.canrad.2011.05.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2011] [Revised: 05/14/2011] [Accepted: 05/25/2011] [Indexed: 12/27/2022]
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Abstract
The foregoing, it is hoped, has provided at least a taste of the past, present, and future in the use of RT for the elderly population. Based on many ongoing studies, it becomes clear that the radiation oncology world has come to recognize the geriatric population’s ability to tolerate, and perhaps even thrive from, a course of RT, when it is offered appropriately. In the final analysis, it has become clear that no simple age cutoff can substitute for clinical acumen and a thorough assessment of patients’ general health before the best treatment regimen can be chosen. One need only follow the trend both in American and in European trials (the RTOG and the EORTC) to appreciate the acceptance that has taken hold that there need not be an age cutoff so much as a set of clinical criteria, including performance status and other assessments of function and comorbidity, prior to patient enrollment in anational trial. With such an outlook, we eagerly anticipate the results from these trials and look forward to implementing them in our treatment of young and old patients alike.
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Affiliation(s)
- Benjamin Rosenbluth
- Department of Radiation Oncology, Holy Name Medical Center, Teaneck, NJ 07666, USA.
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Management of the Elderly Patient With Gynecologic Cancer: Report of the 2011 Workshop in Geriatric Gynecologic Oncology. Int J Gynecol Cancer 2012; 22:161-9. [DOI: 10.1097/igc.0b013e318234f8d5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
AbstractReflecting the worldwide aging trend and close association of aging with cancer, geriatric oncology is now growing beyond its pioneer years. Nevertheless, geriatric oncology in the gynecologic field is in the beginning stage; indeed, there is no geriatric specialist who is trained in this particular field of gynecologic oncology. Therefore, we held the first workshop in geriatric gynecologic oncology. In this review, we summarize what we discussed at the workshop and provide evidence-based recommendations for the diagnosis and treatment of gynecologic cancer in elderly individuals.
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Sharma C, Deutsch I, Horowitz DP, Hershman DL, Lewin SN, Lu YS, Neugut AI, Herzog TJ, Chao CK, Wright JD. Patterns of care and treatment outcomes for elderly women with cervical cancer. Cancer 2011; 118:3618-26. [DOI: 10.1002/cncr.26589] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 08/16/2011] [Accepted: 08/24/2011] [Indexed: 01/11/2023]
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Gayar OH, Robbins JR, Parikh K, Lu M, Buekers T, Munkarah A, Elshaikh MA. Hysterectomy for uterine adenocarcinoma in the elderly: Tumor characteristics, and long-term outcome. Gynecol Oncol 2011; 123:71-5. [DOI: 10.1016/j.ygyno.2011.06.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Revised: 06/17/2011] [Accepted: 06/25/2011] [Indexed: 10/17/2022]
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Rodrigues AC, Teixeira R, Teixeira T, Conde S, Soares P, Torgal I. Impact of pelvic radiotherapy on female sexuality. Arch Gynecol Obstet 2011; 285:505-14. [PMID: 21769555 DOI: 10.1007/s00404-011-1988-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2010] [Accepted: 07/06/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess physical and psychological morbidity, sexual functioning and social and relationship satisfaction among women treated with pelvic radiotherapy. METHODS Observational (case-control) study of 199 women: 98 submitted to pelvic radiotherapy for the treatment of uterine, rectal or anal cancers and 101 without a personal history of cancer and similar socio-demographic variables. These completed a socio-demographic and clinical questionnaire, and validated measures of psychological health (DASS: Lovibond and Lovibond in Behav Res Ther 33:353-343, 1995), sexual function (FSFI: Rosen et al. in J Sex Marital Ther 26:191-208, 2007), social support (ESSS: Ribeiro in Analise Psicologica 3:547-558, 1999) and relationship satisfaction (IMS: Hudson in The WALMYR assessment scales scoring manual 1992). RESULTS Women submitted to pelvic irradiation reported a higher rate of adverse physical symptoms in the last month: fatigue 59 versus 25% (p < 0.001), lack of strength 42 versus 20% (p = 0.001), diarrhoea 24 versus 12% (p = 0.032), vaginal discharge 17 versus 7% (p = 0.024), skin erythema 9 versus 2% (p = 0.026). Levels of depression, anxiety and stress were higher among radiotherapy patients, but only reach statistical significance for the stress parameter (6.1 vs. 4.0, p = 0.012). Also these women reported lower scores of satisfaction with social support (57.2 vs. 62.2, p = 0.005) and sexual function (8.5 vs. 13.5, p = 0.049). No statistically significant differences occurred between the two groups regarding scores of relationship satisfaction (20.8 vs. 19.9, p = n.s.). CONCLUSIONS Our results suggested that pelvic radiotherapy had a negative impact on female sexuality. Thus, interventions that would help to reduce this impact need to be designed and integrated into routine clinical practice.
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Affiliation(s)
- Ana Cláudia Rodrigues
- Department of Gynecology and Obstetrics, Coimbra University Hospital, Coimbra, Portugal.
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Wright JD, Lewin SN, Barrena Medel NI, Sun X, Burke WM, Deutsch I, Herzog TJ. Endometrial cancer in the oldest old: Tumor characteristics, patterns of care, and outcome. Gynecol Oncol 2011; 122:69-74. [PMID: 21429570 DOI: 10.1016/j.ygyno.2011.02.040] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2011] [Revised: 02/25/2011] [Accepted: 02/28/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Despite the fact that endometrial cancer commonly occurs in elderly women, little is known about the outcome of the oldest old, those > 80 years of age. We examined the patterns of care and outcome of the oldest old women with endometrial cancer. METHODS An analysis of women > 65 years of age with endometrioid adenocarcinoma of the uterus diagnosed between 1988 and 2006 and registered in the Surveillance, Epidemiology, and End Results database was performed. Patients were stratified by age into the following groups: 65-69, 70-74, 75-79, 80-84, and ≥ 85 years of age. Multivariable logistic regression models were constructed to examine treatment while adjusting for other confounders. Cancer-specific survival was examined using Cox proportional hazards models. RESULTS A total of 37,718 women including 5289 aged 80-84 and 3446 ≥ 85 years of age were identified. Older women had higher grade tumors (p<0.0001) and more advanced stage disease (p<0.0001). After adjusting for tumor characteristics, patients ≥ 85 years of age were less likely to undergo hysterectomy (OR=0.14; 95% CI=0.12-0.16) and lymphadenectomy (OR=0.48; 95% CI=0.44-0.54) and less likely to receive radiation (OR=0.41; 95% CI=0.36-0.46). After adjustment for treatment and prognostic factors, cancer-specific mortality was 53% (HR=1.53; 95% CI=1.39-1.67) greater in women 80-84 and 89% (HR=1.89; 95% CI= 1.71-2.08) greater in those ≥ 85 years of age than in women 65-69 years old. CONCLUSION Women > 80 years of age receive less aggressive care than younger women. Even after adjusting for treatment differences, cancer-specific mortality is higher in the oldest old women.
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Affiliation(s)
- Jason D Wright
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
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[Carcinoma of the anal canal: state of art, issues in geriatric oncology and molecular targeted therapies]. Bull Cancer 2011; 98:146-53. [PMID: 21382795 DOI: 10.1684/bdc.2011.1305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Since the 1990, chemoradiation has become the standard treatment for locally advanced anal cancer. Recent progress in molecular biology and the growing number of elderly patients invite the clinicians to personalize the multimodal therapy strategy. However, data about anal cancer and elderly patients or targeted therapy are extremely sparse. Indeed, national or international guidelines don't mention these two subjects. The purpose of this article is to make the state of art of the management of anal cancer and its interferences with geriatrics and molecular targeted therapy.
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Yamazaki H, Yoshida K, Kotsuma T, Yoshioka Y, Koizumi M, Furukawa S, Kakimoto N, Shimizutani K, Nishimura T. Age is not a limiting factor for brachytherapy for carcinoma of the node negative oral tongue in patients aged eighty or older. Radiat Oncol 2010; 5:116. [PMID: 21143904 PMCID: PMC3016284 DOI: 10.1186/1748-717x-5-116] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Accepted: 12/09/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To examine the role of brachytherapy for aged patients 80 or more in the trend of rapidly increasing number. METHODS We examined the outcomes for elderly patients with node negative oral tongue cancer (T1-3N0M0) treated with brachytherapy. The 21 patients (2 T1, 14 T2, and 5 T3 cases) ranged in age from 80 to 89 years (median 81), and their cancer was pathologically confirmed. All patients underwent definitive radiation therapy, with low dose rate (LDR) Ra-226 brachytherapy (n = 4; median 70Gy), with Ir-192 (n = 12; 70Gy), with Au-198 (n = 1) or with high dose rate (HDR) Ir-192 brachytherapy (n = 4; 60 Gy). Eight patients also underwent external radiotherapy (median 30 Gy). The period of observation ranged from 13 months to 14 years (median 2.5 years). We selected 226 population matched younger counterpart from our medical chart. RESULTS Definitive radiation therapy was completed for all 21 patients (100%), and acute grade 2-3 mucositis related to the therapy was tolerable. Local control (initial complete response) was attained in 19 of 21 patients (90%). The 2-year and 5-year local control rates were 91%, (100% for T1, 83% for T2 and 80% for T3 tumors after 2 years). These figures was not inferior to that of younger counterpart (82% at 5-year, n.s.). The cause-specific survival rate was 83% and the regional control rate 84% at the 2-years follow-up. However, 12 patients died because of intercurrent diseases or senility, resulting in overall survival rates of 55% at 2 years and 34% at 5 years. CONCLUSION Age is not a limiting factor for brachytherapy for appropriately selected elderly patients, and brachytherapy achieved good local control with acceptable morbidity.
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Affiliation(s)
- Hideya Yamazaki
- Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-8566 Japan.
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Fiorica F, Berretta M, Colosimo C, Berretta S, Ristagno M, Palmucci T, Palmucci S, Lleshi A, Ursino S, Fisichella R, Spartà D, Stefanelli A, Cappellani A, Tirelli U, Cartei F. Safety and efficacy of radiotherapy treatment in elderly patients with localized prostate cancer: A retrospective analysis. Arch Gerontol Geriatr 2010; 51:277-82. [DOI: 10.1016/j.archger.2009.11.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Revised: 11/24/2009] [Accepted: 11/26/2009] [Indexed: 11/29/2022]
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Laurentius T, Altendorf-Hofmann A, Camara O, Runnebaum IB, Wendt TG. Impact of age on morbidity and outcome of concurrent radiochemotherapy in high-risk FIGO stage I to IVA carcinoma of the uterine cervix following laparoscopic surgery. J Cancer Res Clin Oncol 2010; 137:481-8. [PMID: 20473526 PMCID: PMC3036825 DOI: 10.1007/s00432-010-0903-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Accepted: 04/23/2010] [Indexed: 11/29/2022]
Abstract
Purpose To evaluate the impact of age on treatment-related acute morbidity, on modifications of drug doses and radiotherapy and on disease-free and overall survival in non-elderly and elderly with high-risk cervical cancer treated with concurrent radiochemotherapy following laparoscopic surgery. Methods One hundred and two patients with high-risk FIGO I – IVA cervical cancer (77 non-elderly [<60 years] and 25 elderly [≥60 years]) were treated by radical hysterectomy with lymphadenectomy (n = 91) and postoperative radiochemotherapy or radical radiochemotherapy alone after laparoscopic lymph node dissection (n = 11) patients received five to six cycles of cis-platin, 40 mg/sqm weekly, given concurrently to pelvic radiotherapy of 45–50.4 Gy in 5–6 weeks. Paraaortic radiotherapy with 45 Gy was performed when laparoscopic staging revealed paraaortic node metastases. Acute morbidity was prospectively scored weekly. Toxicity-related protocol violations (treatment breaks or dose reduction) were related with age, 5-year overall survival (OS) and progression-free survival (PFS) rates. Results Clinical stages and histologic subtypes were equally distributed. Grade 3/4 leukopenia, anemia, diarrhea and nausea occurred more frequently in the elderly. 16 (22%) non-elderly and 6 (25%) elderly needed a modification of drug dose. 10/77 (13%) non-elderly patients and 11/25 (44%) of the elderly needed an unscheduled treatment break (p = 0.002). OS and PFS were not different between age groups. The 5-year OS rate was 47 ± 6% for non-elderly patients and 45 ± 10% for the elderly. Patients with/without treatment breaks had a 5-year OS rate of 39 ± 11%/48 ± 6%. The 5-year PFS rate is 49 ± 6% for non-elderly patients and 47 ± 11% for the elderly. Patients with/without treatment breaks had a 5-year PFS probability of 50 ± 12%/48 ± 6%. FIGO stage retains its prognostic significance irrespective of age. Conclusions Concurrent radiochemotherapy caused slightly higher acute toxicity with increasing age. Adjustment of treatment intensity was more frequent in the elderly but did not result in detrimental outcome figures.
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Mongiat-Artus P, Peyromaure M, Richaud P, Droz JP, Rainfray M, Jeandel C, Rebillard X, Moreau JL, Davin JL, Salomon L, Soulié M. Recommandations pour la prise en charge du cancer de la prostate chez l’homme âgé : un travail du comité de cancérologie de l’association française d’urologie. Prog Urol 2009; 19:810-7. [DOI: 10.1016/j.purol.2009.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Revised: 01/19/2009] [Accepted: 02/04/2009] [Indexed: 11/16/2022]
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Richaud P, Salomon L, Mongiat-Artus P, Gaschignard N, Beuzeboc P, Peyromaure M, Bastide C, Cornud F, Molinié V, Rozet F, Staerman F, Soulié M. Place et principes de la radiothérapie dans le cancer de la prostate du sujet âgé. Prog Urol 2009; 19 Suppl 3:S156-9. [DOI: 10.1016/s1166-7087(09)73364-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Hennequin C, Quéro L. Cancers urologiques du sujet âgé : rôle de la radiothérapie. Prog Urol 2009; 19 Suppl 3:S96-9. [DOI: 10.1016/s1166-7087(09)73352-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Talaat A, Brinkmann D, Nagar Y, Hogston P, Khoury G, Woolas R. Experience in the management of patients older than 80 years with vulval cancer. Int J Gynecol Cancer 2009; 19:752-5. [PMID: 19509583 DOI: 10.1111/igc.0b013e31819d7d31] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Vulval cancer is a disease of an increasing elderly population and consequently comorbidities are common. These conditions may preclude the application of standard therapy. OBJECTIVE To review the outcome of women with vulval cancer older than 80 years comparing those who received recommended treatment (protocol-adherent) with those who did not (protocol-violated). METHODS A retrospective chart review of a consecutive series of patients discussed over a 6-year period at our Multidisciplinary Team meeting. Treatment was deemed protocol-adherent if the Royal College of Obstetricians and Gynaecologists guidelines were followed and protocol-violated if not. Outcome data were retrieved from case notes, primary care input, cancer registry database, and reviewed in terms of survival and recurrence. RESULTS Twenty-three cases of squamous cell carcinoma of the vulva were identified between 1999 and 2005 at Portsmouth Oncology Centre. Eight women were protocol-adherent and 15 women were not. Treatment decisions were made after individual discussion in conjunction with performance status. Protocol adherence was associated with a 25% recurrence rate and violation with a 53% recurrence rate. Median survival was shorter in the protocol-violated group compared with the adherent group (18 months vs 43.5 months respectively). CONCLUSION These data imply that this issue arises not infrequently, perhaps every 3 to 4 months at each gynecological oncology Multidisciplinary Team meeting in the UK. The higher recurrence rate and shorter median survival among the protocol-violated group supports the validity of the current Royal College of Obstetricians and Gynaecologists treatment guidelines in this elderly age group. A prospective scoring system should be evolved to ensure a more objective approach to such patients with considerable co-morbidities.
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Affiliation(s)
- Ahmed Talaat
- Department of Gynaecological Oncology, St. Mary's Hospital, Portsmouth, UK.
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Durdux C, Boisserie T, Gisselbrecht M. [Radiation therapy in elderly patients]. Cancer Radiother 2009; 13:609-14. [PMID: 19729331 DOI: 10.1016/j.canrad.2009.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Revised: 06/02/2009] [Accepted: 06/03/2009] [Indexed: 11/17/2022]
Abstract
Cancer is a disease that predominantly occurs in older patients who represent a quarter of the population in western countries. Numerous types of cancer are observed in elderly people. Radiotherapy is one of the most powerful treatment against cancer. Most of published studies have demonstrated feasibility of radiotherapy in curative or palliative intent whatever cancer types are considered. Complete geriatric assessment and a multidisciplinary approach are the key points. The purpose of this review is to highlight sights of radiation oncology specifically related to aging. Particular emphasis is placed on logistic and technical aspects of radiation, as dose, irradiated volume and fractionation.
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Affiliation(s)
- C Durdux
- Service de Radiothérapie, Hôpital Européen Georges-Pompidou, 75015 Paris, France.
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[Prostate cancer: what role for curative radiotherapy in elderly?]. Cancer Radiother 2009; 13:623-7. [PMID: 19695936 DOI: 10.1016/j.canrad.2009.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Revised: 06/03/2009] [Accepted: 06/05/2009] [Indexed: 11/21/2022]
Abstract
PURPOSE Discuss the place of radiotherapy given in a curative intent in elderly patients with localised prostate cancer according to complications, local control, survival observed in a specific and a review of the literature. PATIENTS AND METHODS The cohort consisted of 65 males aged 80 or more with localised prostate cancer who choose radiotherapy as a curative modality. Twelve radiotherapy centres affiliated to the Rare Cancer Network participated to the study. The retrospective analysis was carried out on immediate and late side-effects, biological free of relapse survival and global survival. Multivariate analysis took into account the comorbidities, the initial prostatic specific antigen (PSA) value, the Gleason score and the therapeutic modalities. RESULTS From January 1990 to December 2000, 65 patients were included into the cohort. Mean age was 81 years. The specific series consisted of 10 T1, 40 T2 and 15 T3 N0M0. Median follow up was 65 months. Immediate and late complications were comparable to those described in younger patients who received a similar irradiation. There were no negative impact of the treatment on disease free survival and global survival. Recent literature did suggest analogous results. CONCLUSIONS Radiation therapy with a curative intent should not be systematically withheld in elderly patients with localised prostate cancer.
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Fiorica F, Cartei F, Carau B, Berretta S, Spartà D, Tirelli U, Santangelo A, Maugeri D, Luca S, Leotta C, Sorace R, Berretta M. Adjuvant radiotherapy on older and oldest elderly rectal cancer patients. Arch Gerontol Geriatr 2009; 49:54-9. [DOI: 10.1016/j.archger.2008.05.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2007] [Revised: 04/26/2008] [Accepted: 05/05/2008] [Indexed: 12/21/2022]
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Combined Modality Therapy in the Elderly Population. Curr Treat Options Oncol 2009; 10:195-204. [DOI: 10.1007/s11864-009-0105-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2009] [Accepted: 05/19/2009] [Indexed: 12/27/2022]
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Nguyen TD, Azria D, Brochon D, Poortmans P, Miller RC, Scandolaro L, Majewski W, Krengli M, Abacioglu U, Moretti L, Villa S, Akyol F, Jovenin N. Curative external beam radiotherapy in patients over 80 years of age with localized prostate cancer: a retrospective rare cancer network study. Crit Rev Oncol Hematol 2009; 74:66-71. [PMID: 19419885 DOI: 10.1016/j.critrevonc.2009.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Revised: 03/26/2009] [Accepted: 04/02/2009] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To analyse tolerance and outcome of patients over 80 years of age who choose external beam radiation therapy to the prostate as a curative treatment. METHODS AND MATERIAL We evaluated acute and late side effects, biological DFS (bDFS) and actuarial survival as well as causes of death in relation to the clinical status including co-morbidity, PSA value, Gleason score and modalities of external radiotherapy in patients with localised prostate cancer >80 years of age. RESULTS From January 1990 to December 2000, 65 eligible cases (median age: 81) were treated by 12 different participating institutions in the Rare Cancer Network. Tumour stage was T1N0M0, T2N0M0 and T3N0M0 for 10, 40, and 15 patients, respectively. Median follow-up was 65 months (range 22-177). Five-year overall survival rate was 77% with a 5-year bDFS rate of 73%. The incidence of grade 3 early toxicity was 12% and 9% for urinary and digestive tract, respectively. CONCLUSIONS Radiation therapy given with curative intent is well tolerated in this selected group of patients aged over 80 years with localised prostate cancer. Results in terms of survival do not suggest a deleterious impact of this treatment. Therefore the authors recommend that radiation therapy with curative intent should not be withheld in selected elderly patients with localised prostate cancer.
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Affiliation(s)
- Tan Dat Nguyen
- Department of Radiation Oncology, Institute Jean-Godinot, Reims, France.
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Durdux C, Bauer C. [Radiation therapy in elderly patients]. Cancer Radiother 2008; 12:548-53. [PMID: 18691927 DOI: 10.1016/j.canrad.2008.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Accepted: 07/01/2008] [Indexed: 10/21/2022]
Abstract
Cancer is a disease that predominantly occurs in older patients who represent a quarter of the population in western countries. Numerous types of cancer are observed in elderly people. Radiotherapy is one of the most powerful treatment against cancer. Most of published studies have demonstrated feasibility of radiotherapy in curative or palliative intent whatever cancer types are considered. Complete geriatric assessment and a multidisciplinary approach are the key points. The purpose of this review is to highlight sights of radiation oncology specifically related to aging. Particular emphasis is placed on logistic and technical aspects of radiation. Special techniques are also reviewed that have particular relevance to the treatment of the elderly.
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Affiliation(s)
- C Durdux
- Service de radiothérapie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
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Martijn H, Vulto J. Should radiotherapy be avoided or delivered differently in elderly patients with rectal cancer? Eur J Cancer 2007; 43:2301-6. [DOI: 10.1016/j.ejca.2007.06.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Revised: 06/20/2007] [Accepted: 06/27/2007] [Indexed: 12/13/2022]
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Abstract
Delivering radiotherapy to the geriatric cancer patient raises several questions: Are there objective reasons to consider the elderly population as potentially more vulnerable to radiation therapy than younger people? In practice, how are geriatric patients treated when radiotherapy is indicated? Recent data from French tumor registries on rectal cancers are reviewed to illustrate the evolution of the practices during a 20-year period up to 2000. Is there a changing landscape in radiotherapy research protocols in the elderly? Thirty-one European Organisation for Research and Treatment of Cancer (Brussels, Belgium) radiotherapy protocols are analyzed regarding compliance to the 1996 recommendation of having no upper age limit when other eligibility factors are fulfilled. To conclude, specific recommendations for optimal radiotherapeutic management of geriatric patients are made for some common cancers in the elderly.
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Lorchel F, Peignaux K, Créhange G, Bosset M, Puyraveau M, Mercier M, Bosset JF, Maingon P. Preoperative radiotherapy in elderly patients with rectal cancer. ACTA ACUST UNITED AC 2007; 31:436-41. [PMID: 17483785 DOI: 10.1016/s0399-8320(07)89407-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE We performed a retrospective analysis in order to evaluate the compliance with preoperative radiotherapy in patients aged>or=70 with locally advanced resectable rectal cancer, and to evaluate the influence of comorbidities on treatment tolerance and oncological results. METHODS From March 1984 to December 2000, 95 patients with T3-T4 N0 M0 rectal cancer received a preoperative radiotherapy in 2 radiotherapy departments. Nineteen patients received concomitant chemotherapy. RESULTS All patients completed the radiation schedule. Six patients suffered grade 3 acute WHO toxicity. Surgical resection was performed in 87 patients. There were 3 post-operative deaths. Analysis of peri-operative complications showed thromboembolism (4.9%), ileus (9.8%) and diarrhoea (6.1%). After a median follow-up of 29 months, the 3- and 5-year overall survival rates were 65% and 49% respectively. In univariate analysis, a tumour located in the mid part of the rectum, a radiation dose less than 40 Gy, the absence of chemotherapy were significantly associated with a poor prognosis. There was a trend to a better survival for patients with a Charlson score of 0 (P=0.0584). In multivariate analysis, only initial WHO performance status was significant. CONCLUSIONS Compliance with preoperative radiotherapy is good in elderly patients. Toxicity rates are similar to those described in randomised trials in which only younger patients were included. Initial WHO performance status<or=1 is significantly associated with better survival.
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Affiliation(s)
- Fabrice Lorchel
- Service d'Oncologie-Radiothérapie, CHU Jean Minjoz, 25030 Besançon Cedex, France.
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Fallai C, Cerrotta A, Valvo F, Badii D, Olmi P. Anal carcinoma of the elderly treated with radiotherapy alone or with concomitant radio-chemotherapy. Crit Rev Oncol Hematol 2006; 61:261-8. [PMID: 17085056 DOI: 10.1016/j.critrevonc.2006.09.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2006] [Revised: 09/14/2006] [Accepted: 09/27/2006] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To analyse the results achieved with radio-chemotherapy (RTCT) or radiotherapy alone (RT) in elderly patients (pts) affected with squamous cell anal cancer. METHODS AND MATERIALS From 1990 to 2002, 62 pts aged > or =70 years were treated with RT (14) or RTCT (48). There were 9 stage I, 29 stage II, 11 stage IIIa and 13 stage IIIb. MMC+5FU was given concomitantly with RT in an early period, later replaced by Cddp+5FU. In the RTCT group, 36Gy were delivered to pelvic+inguinal lymph nodes, with a tumor boost (18Gy). RESULTS Stage II fared significantly better than stage III in terms of locoregional control (LRC) but not overall survival (OS). Pts treated with RTCT had improved LRC, but not OS. LRC was 81% at 3 and 5 years for the RTCT group; the RT group had a LRC of 61% at 3 years. There were more locoregional relapses in the MMC group (29%) versus the Cddp group (19%) and in pts treated with a split (32%) versus no split (19%). No G3 acute toxicity was observed in the RT group; in the RTCT group 15 pts (31%) developed a G3+ acute toxicity. G3+ late damage occurred in 2 pts in the RT only group and in 3 pts in the RTCT group. CONCLUSIONS Elderly people considered fit for RTCT should undergo the same schedules used for younger people. MMC or Cddp+5FU are feasible in the elderly, even without a planned split.
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Affiliation(s)
- Carlo Fallai
- Radioterapia, Istituto Nazionale Tumori, Via Venezian 1, 20133 Milano, Italy.
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Lachance JA, Everett EN, Greer B, Mandel L, Swisher E, Tamimi H, Goff B. The effect of age on clinical/pathologic features, surgical morbidity, and outcome in patients with endometrial cancer. Gynecol Oncol 2006; 101:470-5. [PMID: 16413048 DOI: 10.1016/j.ygyno.2005.11.009] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2005] [Revised: 11/02/2005] [Accepted: 11/07/2005] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the effect of age on clinical/pathologic features, surgical morbidity, and outcome in patients with endometrial cancer. METHODS All women with surgically treated endometrial cancer at the University of Washington in Seattle, Washington between January 1990 and January 2000 were eligible; 396 patients underwent retrospective chart review. Statistical analysis was performed by SPSS. Median follow-up time was 33 months (range, 1 to 120 months). RESULTS Age was < 45 years in 15% of patients, between 46 and 64 years in 47% of patients, and > 65 years in 38% of patients. Younger patients were statistically more obese than older patients (Body Mass Index of 40.3 kg/m2 vs. 35.3 kg/m2 vs. 31.0 kg/m2, P < 0.001). Intraoperatively, there were no differences between the three groups in the percentage of patients with lymph node sampling, operative time, blood loss, or complications. Postoperatively, older patients had more wound infections (P = 0.002), more cardiac events (P = 0.001), and more episodes of ileus (P = 0.025). Evaluation of pathology revealed that patients < 45 years old were statistically more likely to have endometrioid histology, grade I tumors, and stage IA disease. Women over age 65 were significantly more likely to have papillary serous histology, grade 3 tumors, and stage IC as compared to the younger patients. A subset analysis of patients > 75 years of age showed an increase in the percentage of patients with papillary serous histology (22% vs. 3%, P = 0.055), grade 3 disease (42% vs. 16%, P < 0.001), and stage IC disease (21% vs. 3%, P = 0.001) when compared to patients < 45 years old. Evaluation of endometrioid tumors only revealed a similar pattern of deeper myometrial invasion and higher tumor grade as age increased. CONCLUSIONS Younger patients with endometrial cancer are generally more obese, with lower grade, lower stage disease, and with more favorable histologic cell types. Despite this, approximately a quarter have stage II-IV disease and 9% have positive lymph nodes. The older patients represent a dramatically different subset of patients. They are more likely to have aggressive papillary serous histology, higher grade tumors, and advanced stage disease. Age should be a consideration in appropriate referrals to gynecologic oncologists.
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Affiliation(s)
- J A Lachance
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Box 356460, Seattle, WA 98195, USA
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Geinitz H, Zimmermann FB, Thamm R, Schumertl A, Busch R, Molls M. 3D conformal radiation therapy for prostate cancer in elderly patients. Radiother Oncol 2005; 76:27-34. [PMID: 15990188 DOI: 10.1016/j.radonc.2005.06.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2004] [Revised: 04/05/2005] [Accepted: 06/05/2005] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to evaluate if conformal radiation therapy for localized prostate cancer with doses of 70 Gy is well tolerated in patients aged 75 years or older, and if the side effects and the biochemical recurrence free (bNED) survival are comparable to younger patients. PATIENTS AND METHODS Eighty patients>or=75 years received definitive conformal radiotherapy for prostate cancer. Acute and late side effects as well as bNED survival (ASTRO criteria) were compared to 221 patients younger than 75 years who were treated during the same period of time. RESULTS Median dose to the prostate was 70 Gy in both groups. There were no significant differences in acute or late side effects between age groups. The frequency of grade III late symptoms was low and ranged between 0 and 4% for the evaluated symptoms irrespective of age group. Older patients had a better bNED survival than younger patients (bNED survival at 4 years: 76 vs. 61%, P=0.042). CONCLUSIONS High-dose conformal radiation therapy for prostate cancer is well tolerated in patients aged 75 years or older. In terms of bNED survival radiation treatment is at least as effective as it is for younger patients.
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Affiliation(s)
- Hans Geinitz
- Klinik und Poliklinik für Strahlentherapie und Radiologische Onkologie, Technische Universität, München, Germany.
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Machiels JP, Duck L, Honhon B, Coster B, Coche JC, Scalliet P, Humblet Y, Aydin S, Kerger J, Remouchamps V, Canon JL, Van Maele P, Gilbeau L, Laurent S, Kirkove C, Octave-Prignot M, Baurain JF, Kartheuser A, Sempoux C. Phase II study of preoperative oxaliplatin, capecitabine and external beam radiotherapy in patients with rectal cancer: the RadiOxCape study. Ann Oncol 2005; 16:1898-905. [PMID: 16219623 DOI: 10.1093/annonc/mdi406] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Preoperative radiotherapy has been shown to decrease the local recurrence rate of patients with locally advanced rectal cancer. Capecitabine and oxaliplatin are both active anticancer agents in the treatment of patients with advanced colorectal cancer and have radiosensitizing properties. Therefore, these drugs would be expected to improve effectiveness of preoperative radiotherapy in terms of local control and prevention of distant metastases. PATIENTS AND METHODS Forty patients with rectal cancer (T3-T4 and/or N+) received radiotherapy (1.8 Gy, 5 days a week over 5 weeks, total dose 45 Gy, 3D conformational technique) in combination with intravenous oxaliplatin 50 mg/m2 once weekly for 5 weeks and oral capecitabine 825 mg/m2 twice daily on each day of radiation. Surgery was performed 6-8 weeks after completion of radiotherapy. The main end points were safety and efficacy as assessed by the pathological complete response (pCR). RESULTS The most frequent grade 3/4 adverse event was diarrhea, occurring in 30% of patients. pCR was found in five (14%) patients. According to Dworak's classification, good regression was found in six (18%) additional patients. CONCLUSIONS Combination of preoperative radiotherapy with capecitabine and oxaliplatin is feasible for downstaging rectal cancer.
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Affiliation(s)
- J-P Machiels
- Clinique des Pathologies Tumorales du Colon et du Rectum, Centre du Cancer, Université Catholique de Louvain, Brussels, Belgium.
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Morizane C, Okusaka T, Ito Y, Ueno H, Ikeda M, Takezako Y, Kagami Y, Ikeda H. Chemoradiotherapy for locally advanced pancreatic carcinoma in elderly patients. Oncology 2005; 68:432-7. [PMID: 16020973 DOI: 10.1159/000086985] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2004] [Accepted: 12/12/2004] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Chemoradiotherapy, which is one of the standard treatments for locally advanced pancreatic carcinoma, is considered a high-risk procedure in elderly patients. This study investigated the outcome and tolerability of this treatment in elderly patients. METHODS We reviewed our database from November 1993 to March 2003 and retrospectively examined the clinical data of patients with histologically confirmed exocrine pancreatic carcinomas that were nonresectable but confined to the pancreatic region, who were treated with protracted 5-fluorouracil infusion (200 mg/m2/day) and concurrent radiotherapy (50.4 Gy in 28 fractions over 5.5 weeks). We evaluated the outcome of patients > or =70 years and those <70 years. RESULTS There were 19 patients > or =70 and 39 patients <70. On pretreatment evaluation, the elderly patients showed lower serum albumin levels, lower transaminase levels, better ECOG performance status, more frequent body weight loss and less frequent abdominal and/or back pain with the administration of morphine than the younger patients. There were no significant differences in the frequency of severe toxicity. Neither the response rate nor the incidence of treatment discontinuation differed significantly between the two groups. The median survival time was longer in the elderly patients than in the younger patients (11.3 vs. 9.5 months, p = 0.04). CONCLUSIONS With careful patient selection, chemoradiotherapy can be one of the treatment options for locally advanced pancreatic carcinoma in elderly patients.
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Affiliation(s)
- Chigusa Morizane
- Hepatobiliary and Pancreatic Oncology Division, National Cancer Center Hospital, Tokyo, Japan
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