Recent advances in de-intensification of radiotherapy in elderly cancer patients

Management of prostate cancer in older patients

The incidence of prostate cancer among older men has increased in many countries, including Asian countries. However, older patients are ineligible for inclusion in large randomized trials, and the existing guidelines for the management of patients with prostate cancer do not provide specific treatment recommendations for older men. Therefore, generation of evidence for older patients with prostate cancer is a key imperative. The International Society of Geriatric Oncology has produced and updated several guidelines for management of prostate cancer in older men since 2010. Regarding localized prostate cancer, both surgery and radiotherapy are considered as feasible treatment options for intermediate- and high-risk prostate cancer even in older men, whereas watchful waiting and active surveillance are useful options for a proportion of these patients. With regard to advanced disease, androgen-receptor axis targets and taxane chemotherapy are standard treatment modalities, although dose modification and prevention of adverse events need to be considered. Management strategy for older patients with prostate cancer should take cognizance of not only the chronological age but also psychological and physical condition, socio-economic status and patient preferences. Geriatric assessment and patient-reported health-related quality of life are important tools for assessing health status of older patients with prostate cancer; however, there is a paucity of evidence of the impact of these tools on the clinical outcomes. Personalized management according to the patient's health status and tumour characteristics as well as socio-economic condition may be necessary for treatment of older patients with prostate cancer.

[Malignant Diseases in the Elderly]

A majority of patients with newly diagnosed malignant disease are 70 years old or older. Frailty - i. e. increased vulnerability towards stressors at older age - is a major challenge during the oncological work-up and treatment in the elderly. Therefore, older cancer patients should receive a systematic assessment of frailty by use of standard tools. Assessment results should be carefully considered during oncological treatment decisions, e. g. in interdisciplinary tumor conferences. Moreover, they are prerequisite to initiate geriatric co-management for which there is emerging new evidence. Advances in tumor surgery and irradiation as well as personalized precision medicine with novel targeted drugs have facilitated the treatment of cancer even in old age and frailty. However, patients with such characteristics are at increased risk of complications compared to younger subjects. Physicians and medical staff involved in treatment must therefore co-operate well. This article provides an overview of the current evidence and highlights key aspects of diagnosis and treatment of malignant diseases in the elderly.

Breast cancer in women aged 75 years and older - tumour characteristics and treatment options

Introduction

An optimal approach to older women with breast cancer is still a major challenge. In this paper, we present a retrospective analysis of treatment in patients aged 75 years and older who were treated at the Holycross Cancer Centre in 2015–2019.

Material and methods

The analysed group consisted of 259 women. For estimation of the general status of patients, we used the Geriatric 8 questionnaire. For every patient, an individual treatment plan was established. Survival analysis was performed; disease-free survival (DFS), cancer-specific survival, and overall survival (OS) were calculated by the Kaplan-Meier method. For DFS and OS, the Cox proportional-hazard regression was applied.

Results

The mean age in the analysed group was 80 years. Stage I and II cancer accounted for over 80% of patients. Radical mastectomy was performed in 56% and breast-conserving surgery in over 34% of patients. Sentinel lymph node biopsy was used in 114 patients. Preoperative systemic treatment was applied in 34 and postoperative chemotherapy in 51 patients, respectively. Trastuzumab was used in 23 patients. Postoperative hormonal therapy was applied in 205 and radiotherapy in 178 patients. During the observation after the treatment 32 patients died, while 227 survived. In multivariate analysis for DFS hormonotherapy was statistically significant for OS clinical stage and hormonotherapy.

Conclusions

The treatment plan for older women consisted of surgery and radiation therapy, and systemic treatment should be always considered. The decision should be made by the breast cancer team.