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Kumar R, Sherwani Z, Lopez M, Vergalasova I, Zhang X, Eckroate B, Hollingsworth J, Girda E, Hathout L. Disparities in brachytherapy utilization in cervical cancer in the United States: A comprehensive literature review. Gynecol Oncol 2023; 179:79-84. [PMID: 37944329 DOI: 10.1016/j.ygyno.2023.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/23/2023] [Accepted: 10/25/2023] [Indexed: 11/12/2023]
Abstract
Brachytherapy (BT) is an integral component of treatment for patients with locally advanced cervical cancer, significantly improving local control and overall survival. There is an overall trend of decreased utilization of BT in United States (US) in the last few decades with around 50% of patients being treated without BT. The cause of decreased utilization is multifactorial including physician comfort, facility volume, low reimbursements rates and costs of starting and maintaining a brachytherapy program. This decrease coincides with an increase in the use of newer advanced techniques like intensity modulated radiation therapy (IMRT) and stereotactic body radiation therapy (SBRT) boost resulting in inferior oncological outcomes and increased toxicity. Moreover, racial and socioeconomic disparities in BT utilization have been widely reported in the US. Various factors including age, race, socio-economic status, location, facility type, facility volume and insurance status result in limited access to brachytherapy, which jeopardizes oncologic outcomes. This comprehensive review discusses the BT utilization in the US, examines the impact of race and socioeconomic factors on BT utilization, and highlights its impact on outcomes.
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Affiliation(s)
- Ritesh Kumar
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States of America
| | - Zohaib Sherwani
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States of America
| | - Melissa Lopez
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States of America
| | - Irina Vergalasova
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States of America
| | - Xinxin Zhang
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States of America
| | - Brett Eckroate
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States of America
| | - Jessie Hollingsworth
- Department of Gynecology Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States of America
| | - Eugenia Girda
- Department of Gynecology Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States of America
| | - Lara Hathout
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States of America.
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Shou H, Wan Q, Xu H, Shi L, Song T. Stage IIB-IVA cervix carcinoma in elderly patients treated with radiation therapy: a longitudinal cohort study by propensity score matching analysis. BMC Womens Health 2023; 23:270. [PMID: 37198594 DOI: 10.1186/s12905-023-02427-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 05/10/2023] [Indexed: 05/19/2023] Open
Abstract
OBJECTIVE We aimed to evaluate the treatment modality and prognostic impact of the age at diagnosis on stage IIB-IVA cervix carcinoma (CC) patients who received radiotherapy (RT).The evaluation was performed using the Surveillance, Epidemiology, and End Results (SEER) database. PATIENTS AND METHODS From the SEER database, we included the patients with a histopathological diagnosis of CC between 2004 and 2016. Subsequently, we compared the treatment outcomes between patients aged ≥ 65 years (OG) and < 65 years (YG) by propensity score matching (PSM) analysis and Cox proportional hazard regression models. RESULTS The data of 5,705 CC patients were obtained from the SEER database. We observed that the OG patients were significantly less likely to receive chemotherapy, brachytherapy, or combination treatment compared to the YG (P < 0.001). Further, the advanced age at diagnosis was an independent prognostic factor associated with decreasing overall survival (OS) before and after PSM. Even in the subgroup analysis of patients who received trimodal therapy, an advanced age had a significant negative impact on OS compared to their younger counterparts. CONCLUSION Advanced age is associated with less aggressive treatment regimens and is independently associated with impaired OS for stage IIB-IVA CC patients who received RT. Hence, future studies should incorporate geriatric assessment into clinical decision-making to select appropriate and effective treatment strategies for elderly CC patients.
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Affiliation(s)
- Huafeng Shou
- Department of Gynecology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, 310014, Zhejiang, People's Republic of China
| | - Qiuyan Wan
- Department of Gynecologic Oncology, Jiangxi Cancer Hospital, Nanchang, 330029, Jiangxi, People's Republic of China
| | - Hong'en Xu
- Cancer Center, Department of Radiation Oncology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Zhejiang, 310014, Hangzhou, P.R. China
| | - Lei Shi
- Cancer Center, Department of Radiation Oncology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Zhejiang, 310014, Hangzhou, P.R. China
| | - Tao Song
- Cancer Center, Department of Radiation Oncology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Zhejiang, 310014, Hangzhou, P.R. China.
- Cancer Center, Department of Radiation Oncology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, No. 158, Shangtang Road, Gongshu District, Hangzhou, 310000, P. R. China.
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Cervical cancer in older women: Does age matter? Maturitas 2022; 158:40-46. [DOI: 10.1016/j.maturitas.2021.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 11/03/2021] [Accepted: 11/16/2021] [Indexed: 12/24/2022]
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Kissel M, Rambeau A, Achkar S, Lecuru F, Mathevet P. Challenges and advances in cervix cancer treatment in elder women. Cancer Treat Rev 2020; 84:101976. [PMID: 32006796 DOI: 10.1016/j.ctrv.2020.101976] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 01/18/2023]
Abstract
With population ageing, cancer treatments in elder patients is becoming a true public health care issue. There is an authentic dilemma between patient's frailty, residual life expectancy and the toll that take anticancer treatments. Since elder patients are almost always excluded from clinical trials, it is hard to get robust scientific data on the tolerability of oncologic treatments and to set in place recommendations. Cervix cancer is traditionally diagnosed in younger women but it has a 2nd incidence peak between 60 and 70 years old. Cervix cancer in elder patients is a subject to many questions in terms of screening and is a therapeutic challenge. This article reviews literature data on these different aspects, from screening to surgery, from radiotherapy to brachytherapy, from chemotherapy to supportive care, from immunotherapy to geriatric assessment. We tried to show how modern therapeutic innovations may benefit elder patients. Expected benefits in terms of efficacy and toxicity may overcome the long-lasting tendency to undertreatment in elder patients and improve their quality of life after cancer treatment. In 2020, there seems to be less and less reasons justifying that elder women with cervix cancer may not receive the appropriate treatment.
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Affiliation(s)
- M Kissel
- Radiation Oncology Department, Institut Gustave Roussy, Villejuif, France.
| | - A Rambeau
- Department of Medical Oncology, Centre François Baclesse, ARCHADE, Caen, France
| | - S Achkar
- Radiation Oncology Department, Institut Gustave Roussy, Villejuif, France
| | - F Lecuru
- Department of Gynecologic Oncology, Georges Pompidou European Hospital, Paris, France
| | - P Mathevet
- Gynecology Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Espenel S, Limkin E, Garcia MA, Langrand-Escure J, Vallard A, Chargari C, Magné N. [Brachytherapy: When needs overtake care offer]. Bull Cancer 2019; 106:584-589. [PMID: 31084914 DOI: 10.1016/j.bulcan.2019.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 03/19/2019] [Accepted: 03/19/2019] [Indexed: 01/01/2023]
Abstract
Brachytherapy has the unique characteristic of being able to deliver high doses to a very localized volume, and remains one of the radiotherapy techniques that has an unparalleled therapeutic index. However, its use has been declining in the past years. Globally, only 55 to 88 % of patients with locally advanced cervical cancer benefit from utero-vaginal brachytherapy, despite the fact that it is proven to enhance both progression-free and overall survival. A decline in the use of low dose rate brachytherapy has likewise been described in the treatment of low-risk and favorable intermediate-risk prostate cancers. Several factors could explain this. First, the radiation oncologists who have the proficiency to perform brachytherapy seems to be inadequate, as it is a technique that requires training and expertise for optimal applications. In many cancer care centers, the caseload is insufficient to provide this experience. Second, the increasing use of technically advanced external beam radiation therapy, such as intensity modulated radiation therapy, offers an easier substitute with more lucrative benefits, resulting in decreased utilization of brachytherapy. However, when brachytherapy is not delivered, a poorer survival rate is reported in locally advanced cervical cancer, and is suggested in intermediate and high-risk prostate cancer. The increasing level of evidence of treatment with brachytherapy necessitates an improvement in its accessibility by having more radiation oncologists as well as cancer centers equipped to perform the procedure.
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Affiliation(s)
- Sophie Espenel
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France; Institut Gustave-Roussy, département de radiothérapie, 114, rue Edouard-Vaillant, 94800 Villejuif, France
| | - Elaine Limkin
- Institut Gustave-Roussy, département de radiothérapie, 114, rue Edouard-Vaillant, 94800 Villejuif, France
| | - Max-Adrien Garcia
- Institut de cancérologie Lucien-Neuwirth, département de santé publique, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Julien Langrand-Escure
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Alexis Vallard
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Cyrus Chargari
- Institut Gustave-Roussy, département de radiothérapie, 114, rue Edouard-Vaillant, 94800 Villejuif, France
| | - Nicolas Magné
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France.
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Albert A, Lee A, Allbright R, Vijayakumar S. Impact of age on receipt of curative treatment for cervical cancer: an analysis of patterns of care and survival in a large, national cohort. J Geriatr Oncol 2019; 10:465-474. [DOI: 10.1016/j.jgo.2018.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/17/2018] [Accepted: 10/09/2018] [Indexed: 11/27/2022]
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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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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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Espenel S, Garcia MA, Trone JC, Guillaume E, Harris A, Rehailia-Blanchard A, He MY, Ouni S, Vallard A, Rancoule C, Ben Mrad M, Chaleur C, De Laroche G, Guy JB, Moreno-Acosta P, Magné N. From IB2 to IIIB locally advanced cervical cancers: report of a ten-year experience. Radiat Oncol 2018; 13:16. [PMID: 29394940 PMCID: PMC5796580 DOI: 10.1186/s13014-018-0963-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 01/24/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Despite screening campaigns, cervical cancers remain among the most prevalent malignancies and carry significant mortality, especially in developing countries. Most studies report outcomes of patients receiving the usual standard of care. It is possible that these selected patients may not correctly represent patients in a real-world setting, which may be a limitation in interpreting outcomes. This study was undertaken to identify prognostic factors, management strategies and outcomes of locally advanced cervical cancers (LACC) treated in daily clinical practice. METHODS Medical files of all consecutive patients treated with curative intent for LACC in a French Cancer Care Center between 2004 and 2014 were reviewed retrospectively. RESULTS Ninety-four patients were identified. Performance status was ≥ 2 in 10.6%. Median age at diagnosis was 63.0. Based on the International Federation of Gynecology and Obstetrics classification, tumours were classified as follows: 10.6% IB2, 22.3% IIA, 51.0% IIB, 4.3% IIIA and 11.7% IIIB. Pelvic lymph nodes were involved in 34.0% of cases. Radiotherapy was delivered for all patients. Radiotherapy technique was intensity modulated radiation therapy or volumetric modulated arc therapy in 39.4% of cases. A concurrent cisplatin chemotherapy was delivered in 68.1% of patients. Brachytherapy was performed in 77.7% of cases. The recommended standard care (concurrent chemoradiotherapy with at least five chemotherapy cycles during radiotherapy, followed by brachytherapy) was delivered in 43.6%. The median overall treatment time was 56 days. Complete tumour sterilisation was achieved in 55.2% of cases. Mean follow-up was 54.3 months. Local recurrence rate was 18.1%. Five-year overall survival was 61.9% (95% Confident Interval (CI) = 52.3-73.2) and five-year disease-specific survival was 68.5% (95% CI = 59.2-79.2). Poor performance status, lymph nodes metastasis and absence of concurrent chemotherapy were identified as poor prognostic factors in multivariate analysis. CONCLUSIONS Less than 50% of patients received the standard care. Because LACC patients and disease are heterogeneous, treatment tailoring appears to be common in current clinical practice. However, guidelines for tailoring management are not currently available. More data about real-world settings are required in order to to optimise clinical trials' aims and designs, and make them translatable in daily clinical practice. TRIAL REGISTRATION retrospectively registered.
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Affiliation(s)
- Sophie Espenel
- Radiotherapy Department, Lucien Neuwirth Cancer Institute, 108 bis avenue Albert Raimond, BP60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Max-Adrien Garcia
- Public Health Department, Lucien Neuwirth Cancer Institute, 108 bis avenue Albert Raimond, BP60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Jane-Chloé Trone
- Radiotherapy Department, Lucien Neuwirth Cancer Institute, 108 bis avenue Albert Raimond, BP60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Elodie Guillaume
- Radiotherapy Department, Lucien Neuwirth Cancer Institute, 108 bis avenue Albert Raimond, BP60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Annabelle Harris
- Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH UK
| | - Amel Rehailia-Blanchard
- Radiotherapy Department, Lucien Neuwirth Cancer Institute, 108 bis avenue Albert Raimond, BP60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Ming Yuan He
- Radiotherapy Department, Lucien Neuwirth Cancer Institute, 108 bis avenue Albert Raimond, BP60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Sarra Ouni
- Radiotherapy Department, Lucien Neuwirth Cancer Institute, 108 bis avenue Albert Raimond, BP60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Alexis Vallard
- Radiotherapy Department, Lucien Neuwirth Cancer Institute, 108 bis avenue Albert Raimond, BP60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Chloé Rancoule
- Radiotherapy Department, Lucien Neuwirth Cancer Institute, 108 bis avenue Albert Raimond, BP60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Majed Ben Mrad
- Radiotherapy Department, Lucien Neuwirth Cancer Institute, 108 bis avenue Albert Raimond, BP60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Céline Chaleur
- Obstetrics and Gynecology Department, Saint Etienne University Hospital Medical Center, avenue Albert Raimond, BP60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Guy De Laroche
- Radiotherapy Department, Lucien Neuwirth Cancer Institute, 108 bis avenue Albert Raimond, BP60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Jean-Baptiste Guy
- Radiotherapy Department, Lucien Neuwirth Cancer Institute, 108 bis avenue Albert Raimond, BP60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Pablo Moreno-Acosta
- Research Group in Radiobiology Clinical, Molecular and Cellular, National Cancer Institute, Bogotá, Colombia
- Research Group in Cancer Biology, National Cancer Institute, Bogotá, Colombia
| | - Nicolas Magné
- Radiotherapy Department, Lucien Neuwirth Cancer Institute, 108 bis avenue Albert Raimond, BP60008, 42271 Saint-Priest-en-Jarez cedex, France
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Torgeson A, Boothe D, Poppe MM, Suneja G, Gaffney DK. Disparities in care for elderly women with endometrial cancer adversely effects survival. Gynecol Oncol 2017; 147:320-328. [DOI: 10.1016/j.ygyno.2017.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/01/2017] [Accepted: 08/04/2017] [Indexed: 10/19/2022]
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Definitive Chemoradiotherapy in Elderly Cervical Cancer Patients: A Multiinstitutional Analysis. Int J Gynecol Cancer 2017; 27:1446-1454. [DOI: 10.1097/igc.0000000000001029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectiveThe aim of the study was to investigate the prognostic factors for survival and treatment-related toxicities in older (≥65 years) cervical cancer patients treated with definitive chemoradiotherapy. In addition, we sought to compare the outcomes between the older elderly (≥75 years) and their younger old counterparts (age, 65–74 years).Materials and MethodsWe retrospectively reviewed medical records from 269 biopsy-proven nonmetastatic cervical cancer patients treated with external radiotherapy and intracavitary brachytherapy at the departments of radiation oncology in 2 different universities. The prognostic factors for survival, local control, and distant metastasis (DM) were analyzed.ResultsThe median follow-up time was 38.8 months (range, 1.5–175.5 months) for the entire cohort and 70.0 months (range, 6.1–175.7 months) for survivors. The 2- and 5-year overall survival (OS), disease-free survival (DFS), and cause-specific survival rates were 66% and 42%, 63% and 39%, and 72% and 55%, respectively. Patients 75 years or older showed significantly worse OS compared with patients aged 65 to 74 years but showed no significant difference in DFS. The 2- and 5-year local control rates were 86% and 71%, respectively. The incidences of DMs at 2 and 5 years were 22% and 30%, respectively. In multivariate analysis, vaginal infiltration and lymph node metastasis were predictive of OS, DFS, local recurrence, and DM. Concomitant chemotherapy was predictive of OS, DFS, and local recurrence, and larger tumor (>4 cm) was a significant prognostic factor for local recurrence. None of the patients had toxicity that necessitated the discontinuation of radiotherapy. All patients were evaluable for acute toxicity, and no grade higher than 3 adverse events occurred during external beam radiation therapy or brachytherapy.ConclusionsAlthough age limited the delivery of aggressive treatment, concurrent chemoradiotherapy in elderly patients associated with improved outcomes similar as in younger counterparts without increasing serious acute and late toxicities.
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American Brachytherapy Society consensus statement for soft tissue sarcoma brachytherapy. Brachytherapy 2017; 16:466-489. [DOI: 10.1016/j.brachy.2017.02.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 02/04/2017] [Accepted: 02/06/2017] [Indexed: 12/31/2022]
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13
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Differences in the outcomes and complications between elderly and younger uterine cervical cancer patients treated by definitive radiotherapy — A propensity score-matched study. Gynecol Oncol 2017; 145:277-283. [DOI: 10.1016/j.ygyno.2017.02.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 02/15/2017] [Accepted: 02/21/2017] [Indexed: 01/23/2023]
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14
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Poupon C, Bendifallah S, Ouldamer L, Canlorbe G, Raimond E, Hudry N, Coutant C, Graesslin O, Touboul C, Collinet P, Bricou A, Huchon C, Daraï E, Ballester M, Levêque J, Lavoue V. Management and Survival of Elderly and Very Elderly Patients with Endometrial Cancer: An Age-Stratified Study of 1228 Women from the FRANCOGYN Group. Ann Surg Oncol 2016; 24:1667-1676. [DOI: 10.1245/s10434-016-5735-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Indexed: 12/20/2022]
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15
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Dumas L, Ring A, Butler J, Kalsi T, Harari D, Banerjee S. Improving outcomes for older women with gynaecological malignancies. Cancer Treat Rev 2016; 50:99-108. [PMID: 27664393 PMCID: PMC5821169 DOI: 10.1016/j.ctrv.2016.08.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 08/19/2016] [Accepted: 08/20/2016] [Indexed: 12/13/2022]
Abstract
The incidence of most gynaecological malignancies rises significantly with increasing age. With an ageing population, the proportion of women over the age of 65 with cancer is expected to rise substantially over the next decade. Unfortunately, survival outcomes are much poorer in older patients and evidence suggests that older women with gynaecological cancers are less likely to receive current standard of care treatment options. Despite this, older women are under-represented in practice changing clinical studies. The evidence for efficacy and tolerability is therefore extrapolated from a younger; often more fit population and applied to in every day clinical practice to older patients with co-morbidities. There has been significant progress in the development of geriatric assessment in oncology to predict treatment outcomes and tolerability however there is still no clear evidence that undertaking a geriatric assessment improves patient outcomes. Clinical trials focusing on treating older patients are urgently required. In this review, we discuss the evidence for treatment of gynaecological cancers as well as methods of assessing older patients for therapy. Potential biomarkers of ageing are also summarised.
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Affiliation(s)
- Lucy Dumas
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, United Kingdom
| | - Alistair Ring
- Breast Unit, Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, United Kingdom
| | - John Butler
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, United Kingdom
| | - Tania Kalsi
- Department of Ageing and Health, 9th Floor North Wing, St Thomas' Hospital, Guys & St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, United Kingdom; Division of Health and Social Care Research, King's College London, Capital House, 42 Weston Street, London SE1 3QD, United Kingdom
| | - Danielle Harari
- Department of Ageing and Health, 9th Floor North Wing, St Thomas' Hospital, Guys & St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, United Kingdom; Division of Health and Social Care Research, King's College London, Capital House, 42 Weston Street, London SE1 3QD, United Kingdom
| | - Susana Banerjee
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, United Kingdom.
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Lin MY, Kondalsamy-Chennakesavan S, Bernshaw D, Khaw P, Narayan K. Carcinoma of the cervix in elderly patients treated with radiotherapy: patterns of care and treatment outcomes. J Gynecol Oncol 2016; 27:e59. [PMID: 27550405 PMCID: PMC5078822 DOI: 10.3802/jgo.2016.27.e59] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 06/18/2016] [Accepted: 06/27/2016] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The aim of this analysis was to examine the management of cervix cancer in elderly patients referred for radiotherapy and the results of treatment in terms of overall survival (OS), relapse-free survival (RFS), and treatment-related toxicities. METHODS Patients were eligible if they were aged ≥75 years, newly diagnosed with cervix cancer and referred for radiotherapy as part of their treatment. Patient details were retrieved from the gynaecology service database where clinical, histopathological treatment and follow-up data were prospectively collected. RESULTS From 1998 to 2010, 126 patients aged ≥75 years, met selection criteria. Median age was 81.5 years. Eighty-one patients had definitive radiotherapy, 10 received adjuvant radiotherapy and 35 had palliative radiotherapy. Seventy-one percent of patients had the International Federation of Gynecology and Obstetrics stage 1b-2b disease. Median follow-up was 37 months. OS and RFS at 3 years among those treated with curative intent were 66.6% and 75.9% respectively with majority of patients dying without any evidence of cervix cancer. Grade 2 or more late toxicities were: bladder 5%, bowel 11%, and vagina 27%. Eastern Cooperative Oncology Group (ECOG) status was a significant predictor of OS and RFS with each unit increment in ECOG score increased the risk of death by 1.69 times (p<0.001). CONCLUSION Following appropriate patient selection, elderly patients treated curatively with radiotherapy for cervix cancer have good disease control. Palliative hypofractionated regimens are well tolerated in patients unsuitable for radical treatment.
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Affiliation(s)
- Ming Yin Lin
- Gynae-Oncology Unit, Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia.
| | - Srinivas Kondalsamy-Chennakesavan
- Gynae-Oncology Unit, Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia.,Rural Clinical School, The University of Queensland School of Medicine, Toowoomba, Queensland, Australia
| | - David Bernshaw
- Gynae-Oncology Unit, Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Pearly Khaw
- Gynae-Oncology Unit, Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Kailash Narayan
- Gynae-Oncology Unit, Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
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17
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Méry B, Ndong SM, Guy JB, Assouline A, Falk AT, Valeille A, Trone JC, Rivoirard R, Auberdiac P, Vallard A, Espenel S, Moriceau G, Collard O, Bosacki C, Jacquin JP, de Laroche G, Fournel P, Chargari C, Magné N. Radiotherapy for gynecologic cancer in nonagenarian patients: a framework for new paradigms. CHINESE JOURNAL OF CANCER 2016; 35:43. [PMID: 27160517 PMCID: PMC4862062 DOI: 10.1186/s40880-016-0104-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 04/18/2016] [Indexed: 11/10/2022]
Abstract
No consensus exists regarding the role of radiotherapy in the management of gynecologic cancer in nonagenarian patients. We retrospectively reviewed the outcomes of 19 consecutive nonagenarian patients with gynecologic cancer (6 endometrial cancers, 6 cervical cancers, 4 vulvar cancers, and 3 vaginal cancers) who were treated with radiotherapy. Radiotherapy was performed mainly in a palliative setting (n = 12; 63.2%), with a median dose of 45 Gy (range, 6-76 Gy). Infrequent major acute or late toxicities were reported. Among 19 patients, 9 (47.4%) experienced tumor progression, 5 (26.3%) experienced complete response, 2 (10.5%) experienced stable disease and/or partial response. At last follow-up, 12 patients (63.2%) had died; most deaths (n = 9) occurred because of the cancer. These results suggest that radiotherapy is feasible in the treatment of nonagenarian patients with gynecologic cancer.
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Affiliation(s)
- Benoîte Méry
- Department of Medical Oncology, Lucien Neuwirth Cancer Institute, 42271, Saint Priest En Jarez, France
| | - Sylvie Mengue Ndong
- Department of Radiotherapy, Lucien Neuwirth Cancer Institute, 42271, Saint Priest En Jarez, France
| | - Jean-Baptiste Guy
- Department of Radiotherapy, Lucien Neuwirth Cancer Institute, 42271, Saint Priest En Jarez, France
| | - Avi Assouline
- Department of Radiotherapy, Porte De Saint Cloud Clinical Center, 92100, Boulogne-Billancourt, France
| | - Alexander T Falk
- Department of Radiation Oncology, Antoine Lacassagne Center, 06100, Nice, France
| | - Anaïs Valeille
- Department of Radiotherapy, Lucien Neuwirth Cancer Institute, 42271, Saint Priest En Jarez, France
| | - Jane-Chloé Trone
- Department of Radiotherapy, Lucien Neuwirth Cancer Institute, 42271, Saint Priest En Jarez, France
| | - Romain Rivoirard
- Department of Medical Oncology, Lucien Neuwirth Cancer Institute, 42271, Saint Priest En Jarez, France
| | - Pierre Auberdiac
- Department of Radiotherapy, Claude Bernard Private Hospital, 81000, Albi, France
| | - Alexis Vallard
- Department of Radiotherapy, Lucien Neuwirth Cancer Institute, 42271, Saint Priest En Jarez, France
| | - Sophie Espenel
- Department of Radiotherapy, Lucien Neuwirth Cancer Institute, 42271, Saint Priest En Jarez, France
| | - Guillaume Moriceau
- Department of Medical Oncology, Lucien Neuwirth Cancer Institute, 42271, Saint Priest En Jarez, France
| | - Olivier Collard
- Department of Medical Oncology, Lucien Neuwirth Cancer Institute, 42271, Saint Priest En Jarez, France
| | - Claire Bosacki
- Department of Medical Oncology, Lucien Neuwirth Cancer Institute, 42271, Saint Priest En Jarez, France
| | - Jean-Philippe Jacquin
- Department of Medical Oncology, Lucien Neuwirth Cancer Institute, 42271, Saint Priest En Jarez, France
| | - Guy de Laroche
- Department of Radiotherapy, Lucien Neuwirth Cancer Institute, 42271, Saint Priest En Jarez, France
| | - Pierre Fournel
- Department of Medical Oncology, Lucien Neuwirth Cancer Institute, 42271, Saint Priest En Jarez, France
| | - Cyrus Chargari
- Department of Radiotherapy, Val-De-Grâce Military Hospital, 75230, Paris, France
| | - Nicolas Magné
- Department of Radiotherapy, Lucien Neuwirth Cancer Institute, 42271, Saint Priest En Jarez, France.
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18
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Monte Carlo simulation of dose distribution in water around 57Fe3O4 magnetite nanoparticle in the nuclear gamma resonance condition. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/s10751-016-1267-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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19
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Hennequin C, Guillerm S, Quero L. [Radiotherapy in elderly patients, recommendations for the main localizations: Breast, prostate and gynaecological cancers]. Cancer Radiother 2015; 19:397-403. [PMID: 26282214 DOI: 10.1016/j.canrad.2015.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 05/21/2015] [Indexed: 11/18/2022]
Abstract
Modifications of radiotherapy indications or schedules because of age could be discussed in view of a different evolution of the disease or because of specific toxicities. One important aim is to decrease the number of hospital transports. For breast cancer, the rate of local relapse after lumpectomy is lower in old patients; moreover, characteristics of the disease are often more favourable (hormonosensitivity, low grade). However, adjuvant irradiation decreases significantly the incidence of breast relapse and must be systematically proposed. Hypofractionnated schedules must be recommended; limited data are available for accelerated partial breast irradiation in old women and these techniques must not be used in routine. For low or intermediate risk prostate cancer, assessment of comorbidities is crucial before considering any invasive treatment. A life expectancy of at least 10 years is required if a curative approach, potentially toxic is proposed. In this case, radiotherapy is often the good choice, giving less sequelae than surgery. The indication of androgen deprivation must take into account cardiovascular and bone history. Management of gynaecological cancers must follow the same recommendations as in young women. Exclusive postoperative brachytherapy must be recommended in early stage endometrial carcinomas. Brachytherapy must be also systematically integrated in the radiotherapy program for cervix cancers, even in old women.
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Affiliation(s)
- C Hennequin
- Service de cancérologie-radiothérapie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefeaux, 75475 Paris, France; Université Paris Diderot, 1, avenue Claude-Vellefeaux, 75475 Paris, France.
| | - S Guillerm
- Service de cancérologie-radiothérapie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefeaux, 75475 Paris, France; Université Paris Diderot, 1, avenue Claude-Vellefeaux, 75475 Paris, France
| | - L Quero
- Service de cancérologie-radiothérapie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefeaux, 75475 Paris, France; Université Paris Diderot, 1, avenue Claude-Vellefeaux, 75475 Paris, France
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20
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Yanazume Y, Yanazume S, Iio K, Yonekura R, Kojima N, Uchida N, Koriyama C, Douchi T. Major causes of impractical brachytherapy in elderly patients with uterine cervical cancer. J Obstet Gynaecol Res 2015; 40:1725-32. [PMID: 24888940 DOI: 10.1111/jog.12387] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 12/16/2013] [Indexed: 11/29/2022]
Abstract
AIM Incomplete brachytherapy is a major risk factor for recurrence. However, high-dose-rate intracavitary brachytherapy has not been assessed adequately in elderly patients with invasive cervical cancer. The present study investigated the clinical importance of intracavitary brachytherapy and risk factors of incomplete intracavitary brachytherapy in elderly patients with cervical cancer. MATERIAL AND METHODS Subjects were 76 patients aged 70-89 years old with invasive cervical cancer. All subjects were recruited between January 1997 and September 2010, and were planning to receive external beam radiation therapy followed by high-dose-rate intracavitary brachytherapy. Survival rates and the incidence of complications were compared between the 70s and 80s age groups. Risk factors for recurrence in elderly patients were evaluated using multivariate analysis, and risk factors for impractical intracavitary brachytherapy were also estimated. RESULTS No significant differences were observed in 3-year progression-free survival rates or the incidence of complications in the two age groups. Cox multivariate analysis showed that histology (non-squamous cell carcinoma), incomplete intracavitary brachytherapy, and lymph node swelling were significant prognostic factors for recurrence. Impractical application was the major reason for incomplete treatment. Multiple logistic regression analysis revealed that a previous history without vaginal births (P = 0.016) was an independent risk factor for the impractical application, independent of tumor diameter ≥ 4 cm (P = 0.007). CONCLUSIONS Incomplete intracavitary brachytherapy decreased the survival rates of elderly patients. Larger tumors and patients without a history of vaginal births were the two major causes of impractical intracavitary brachytherapy, which may be fatal, especially in elderly patients with bulky tumors.
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Affiliation(s)
- Yumi Yanazume
- Department of Obstetrics and Gynecology, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
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21
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Vallard A, Guy JB, Espenel S, Langrand-Escure J, Trone JC, Méry B, Moriceau G, Rivoirard R, de Laroche G, Chargari C, Magné N. [Elderly patients and radiotherapy: A short review]. Bull Cancer 2015; 102:539-49. [PMID: 25840657 DOI: 10.1016/j.bulcan.2015.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 02/24/2015] [Accepted: 03/05/2015] [Indexed: 10/23/2022]
Abstract
The ageing of French population imposes to radiotherapists the challenge to treat older patients and to adjust their treatment. Unthinkable 30 years ago, radiation therapy concerns nowadays patients aged more than 90 years old. Oncogeriatric scales have been improved those last years without necessarily making sure that the right treatment is given to the right patient: if oncogeriatric scales use influences the final therapeutic decision, it does not define new target volumes, new doses, or new fractionation protocols. Except for some organs, there is not, for the moment, any consensus concerning geriatric population adapted treatments. This makes any therapeutic decision difficult. The present review has for objective to realise a report of the studies about favorable and unfavorable effects of radiation therapy amongst aged (>70 years old) or very aged (>90years old) population.
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Affiliation(s)
- Alexis Vallard
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Jean-Baptiste Guy
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Sophie Espenel
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Julien Langrand-Escure
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Jane-Chloé Trone
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Benoîte Méry
- Institut de cancérologie Lucien-Neuwirth, département d'oncologie médicale, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Guillaume Moriceau
- Institut de cancérologie Lucien-Neuwirth, département d'oncologie médicale, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Romain Rivoirard
- Institut de cancérologie Lucien-Neuwirth, département d'oncologie médicale, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Guy de Laroche
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Cyrus Chargari
- Hôpital d'instruction des armées du Val-de-Grâce, département de radiation oncology, boulevard du Port-Royal, 75013 Paris, France
| | - Nicolas Magné
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France.
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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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24
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Investigation of uterine arterial chemoembolization and uterine arterial infusion chemotherapy for advanced cervical cancer before radical radiotherapy: a long-term follow-up study. Arch Gynecol Obstet 2014; 290:155-62. [DOI: 10.1007/s00404-014-3166-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 01/24/2014] [Indexed: 10/25/2022]
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25
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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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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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Influence of geriatric consultation with comprehensive geriatric assessment on final therapeutic decision in elderly cancer patients. Crit Rev Oncol Hematol 2010; 79:302-7. [PMID: 20888781 DOI: 10.1016/j.critrevonc.2010.08.004] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 07/07/2010] [Accepted: 08/25/2010] [Indexed: 12/18/2022] Open
Abstract
Elderly patients represent a heterogeneous population in which decisions on cancer treatment are often difficult. The present study aims to report a 2-year period of the activity of geriatric assessment consultations and the impact on treatment decisions. Since January 2007, we have systematically carried out geriatric consultations, using well-known international scales, for elderly patients in whom treatment decisions appear complex to oncologists. From January 2007 to November 2008, 161 patients (57 men, 104 women; median age 82.4 years, range 73-97) were seen at geriatric consultations. Most of the patients (134/161) were undergoing first-line treatment and cancer was metastatic in 86 patients (53%). Geriatric assessment found severe comorbidities (grade 3 or 4 in CIRS-G scale) in 75 patients, dependence for at least one activity of daily living (ADL) in 52 patients, cognitive impairment in 42 patients, malnutrition in 104 patients (65%) and depression in 39 patients. According to the oncologists' prior decisions, there were no changes in treatment decisions in only 29 patients. Cancer treatment was changed in 79 patients (49%), including delayed therapy in 5 patients, less intensive therapy in 29 patients and more intensive therapy in 45 patients. Patients for whom the final decision was delayed or who underwent less intensive therapy had significantly more frequent severe comorbidities (23/34, p<0.01) and dependence for at least one ADL (19/34, p<0.01). In this study, we have found that comprehensive geriatric evaluation did significantly influence treatment decisions in 82% of our older cancer patients.
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Radiotherapy for Japanese elderly patients with cervical cancer: preliminary survival outcomes and evaluation of treatment-related toxicity. Arch Gynecol Obstet 2010; 284:1007-14. [PMID: 21116639 PMCID: PMC3171672 DOI: 10.1007/s00404-010-1777-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Accepted: 11/11/2010] [Indexed: 11/22/2022]
Abstract
Purpose To examine the preliminary survival outcomes and treatment-related toxicity for elderly patients with cervical cancer treated with radiotherapy (RT). Methods Forty patients ≥75 years old with cervical cancer who were treated with RT were evaluated. Of these 40 patients, 25 were classified as FIGO stage I or II and 15 as stage III or IVA. Thirty-five patients were treated with radical RT (RRT), and five were treated with surgery plus adjuvant RT (S + ART). External beam radiotherapy combined with high-dose-rate intracavitary brachytherapy was performed on 31 patients who were treated with RRT and on 2 patients who were treated with S + ART because of positive vaginal surgical margins. The patients’ median age was 78 years (range 75–89 years). Concurrent chemotherapy (CCT) was performed on five patients (RRT: 3, S + ART: 2). Results The median follow-up period was 20 months (range 1–85 months). Only one patient could not complete RT. The 3-year overall and disease-specific survival (OS and DSS) rates for all patients were 58 and 80%, respectively. Five patients experienced Grade 3 acute toxicity; two were treated with RRT (2/35), and three were treated with S + ART (3/5, 2 of them with CCT). Two patients experienced Grade 3 late toxicity; one was treated with RRT (1/35, with CCT) and the other was treated with S + ART (1/5). No Grade 4 or higher toxicity was experienced. Conclusions RRT for elderly patients with cervical cancer is generally effective and safe, but severe toxicity may occur with more aggressive treatment modalities.
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Bordón E, Henríquez Hernández LA, Lara PC, Pinar B, Fontes F, Rodríguez Gallego C, Lloret M. Prediction of clinical toxicity in localized cervical carcinoma by radio-induced apoptosis study in peripheral blood lymphocytes (PBLs). Radiat Oncol 2009; 4:58. [PMID: 19941649 PMCID: PMC2787528 DOI: 10.1186/1748-717x-4-58] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Accepted: 11/26/2009] [Indexed: 11/10/2022] Open
Abstract
Background Cervical cancer is treated mainly by surgery and radiotherapy. Toxicity due to radiation is a limiting factor for treatment success. Determination of lymphocyte radiosensitivity by radio-induced apoptosis arises as a possible method for predictive test development. The aim of this study was to analyze radio-induced apoptosis of peripheral blood lymphocytes. Methods Ninety four consecutive patients suffering from cervical carcinoma, diagnosed and treated in our institution, and four healthy controls were included in the study. Toxicity was evaluated using the Lent-Soma scale. Peripheral blood lymphocytes were isolated and irradiated at 0, 1, 2 and 8 Gy during 24, 48 and 72 hours. Apoptosis was measured by flow cytometry using annexin V/propidium iodide to determine early and late apoptosis. Lymphocytes were marked with CD45 APC-conjugated monoclonal antibody. Results Radiation-induced apoptosis (RIA) increased with radiation dose and time of incubation. Data strongly fitted to a semi logarithmic model as follows: RIA = βln(Gy) + α. This mathematical model was defined by two constants: α, is the origin of the curve in the Y axis and determines the percentage of spontaneous cell death and β, is the slope of the curve and determines the percentage of cell death induced at a determined radiation dose (β = ΔRIA/Δln(Gy)). Higher β values (increased rate of RIA at given radiation doses) were observed in patients with low sexual toxicity (Exp(B) = 0.83, C.I. 95% (0.73-0.95), p = 0.007; Exp(B) = 0.88, C.I. 95% (0.82-0.94), p = 0.001; Exp(B) = 0.93, C.I. 95% (0.88-0.99), p = 0.026 for 24, 48 and 72 hours respectively). This relation was also found with rectal (Exp(B) = 0.89, C.I. 95% (0.81-0.98), p = 0.026; Exp(B) = 0.95, C.I. 95% (0.91-0.98), p = 0.013 for 48 and 72 hours respectively) and urinary (Exp(B) = 0.83, C.I. 95% (0.71-0.97), p = 0.021 for 24 hours) toxicity. Conclusion Radiation induced apoptosis at different time points and radiation doses fitted to a semi logarithmic model defined by a mathematical equation that gives an individual value of radiosensitivity and could predict late toxicity due to radiotherapy. Other prospective studies with higher number of patients are needed to validate these results.
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Affiliation(s)
- Elisa Bordón
- Canary Institute for Cancer Research (ICIC), Las Palmas, Spain
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