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Strahlentherapie und Onkologie

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01-01-2019 | Original Article

Feasibility of radiotherapy in nonagenarian patients: a retrospective study

Authors: L. Kocik, H. Geinitz, C. Track, M. Geier, C. Nieder

Published in: Strahlentherapie und Onkologie | Issue 1/2019

Abstract

Purpose

Specific information about radiation therapy in nonagenarians is limited. In order to shed more light on the feasibility of radiotherapy in this challenging subgroup, a retrospective study was performed.

Methods

The data of 93 consecutive patients receiving irradiation treatment at the Department of Radiation Oncology, Ordensklinikum Linz Barmherzige Schwestern between June 2005 and December 2016 were analyzed. Patient- and treatment-related factors were extracted from the patient records. Overall survival (OS) was defined as time from irradiation to death or last follow-up. The survival rates were analyzed using the Kaplan-Meier method and log-rank test.

Results

The study population of 93 patients was between 90 and 99 years old (median 91 years). It included 59 women (63%) and 34 men (37%). Of these, 38 (41%) received definitive radiotherapy, 14 (15%) received neoadjuvant or adjuvant radiotherapy, whereas a palliative regimen was prescribed in 44% of the cases (n = 41). In all, 79 patients (85%) were able to complete their prescribed course of radiotherapy. While 16 (17%) patients reported grade 2 toxicities or higher, 4 had ≥grade 3 side effects (4%). The median survival was significantly higher in patients treated with adjuvant, neoadjuvant or definitive radiotherapy (13.8 months) compared to patients treated with palliative radiotherapy (3.6 months; p < 0.001).

Conclusion

Even in patients managed without preradiotherapy comprehensive geriatric assessment, carefully planned fractionated radiotherapy was feasible and resulted in acceptable rates of acute toxicities.

Vineis P, Wild CP (2014) Global cancer patterns: causes and prevention. Lancet 383:549–557CrossRefPubMed

Rodrigues G, Sanatani M (2012) Age and comorbidity considerations related to radiotherapy and chemotherapy administration. Semin Radiat Oncol 22:277–283CrossRefPubMed

Bouzereau V, Le Caer F, Guardiola E, Scavennec C, Barriere JR, Chaix L, Le Caer H (2013) Experience of multidisciplinary assessment of elderly patients with cancer in a French general hospital during 1year: a new model care study. J Geriatr Oncol 4:394–401CrossRefPubMed

Nieder C, Angelo K, Haukland E, Pawinski A (2014) Survival after palliative radiotherapy in geriatric cancer patients. Anticancer Res 34:6641–6645PubMed

Chen L, Shen C, Redmond KJ, Page BR, Kummerlowe M, Mcnutt T, Bettegowda C, Rigamonti D, Lim M, Kleinberg L (2017) Use of stereotactic radiosurgery in elderly and very elderly patients with brain metastases to limit toxicity associated with whole brain radiation therapy. Int J Radiat Oncol Biol Phys 98:939–947CrossRefPubMed

Cassidy RJ, Patel PR, Zhang X, Press RH, Switchenko JM, Pillai RN, Owonikoko TK, Ramalingam SS, Fernandez FG, Force SD, Curran WJ, Higgins KA (2017) Stereotactic body radiotherapy for early-stage non-small-cell lung cancer in patients 80 years and older: a multi-center analysis. Clin Lung Cancer 18:551–558.e6CrossRefPubMedPubMedCentral

Arnold BN, Thomas DC, Rosen JE, Salazar MC, Detterbeck FC, Blasberg JD, Boffa DJ, Kim AW (2017) Effectiveness of local therapy for stage I non-small-cell lung cancer in nonagenarians. Surgery 162:640–651CrossRefPubMed

Franceschini D, De Rose F, Cozzi L et al (2017) Radical hypo-fractionated radiotherapy with volumetric modulated arc therapy in lung cancer. Strahlenther Onkol 193:385CrossRefPubMed

Andrä C, Klein A, Dürr HR et al (2017) External-beam radiation therapy combined with limb-sparing surgery in elderly patients (>70 years) with primary soft tissue sarcomas of the extremities. Strahlenther Onkol 193:604CrossRefPubMed

10.

Thompson A, Cone R, Gao H, Hammond E, Fraser D, Back MF (2012) Is advanced age a barrier to effective cancer treatment? The experience of nonagenarians receiving radiation therapy. Asia Pac J Clin Oncol 8:255–259CrossRefPubMed

11.

Chargari C, Moriceau G, Auberdiac P, Guy JB, Assouline A, Tinquaut F, Falk AT, Eddekkaoui H, Bourmaud A, Coscas Y, Annede P, Rivoirard R, Mery B, Trone JC, Otmezguine Y, Pacaut C, Bauduceau O, Vedrine L, Merrouche Y, Magne N (2014) Feasibility of radiation therapy in patients 90 years of age and older: a French multicentre analysis. Eur J Cancer 50:1490–1497CrossRefPubMed

12.

Rivoirard R, Moncharmont C, Assouline A, Auberdiac P, Mery B, Falk AT, Annède P, Trone JC, Guy JB, Vial N, Fournel P, Merrouche Y, Chargari C, Magné N (2015) Radiotherapy for head and neck cancer in nonagenarian patients: a possible cornerstone? Eur Arch Otorhinolaryngol 272:719–725CrossRefPubMed

13.

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 (2016) Radiotherapy for gynecologic cancer in nonagenarian patients: a framework for new paradigms. Chin J Cancer 35:43CrossRefPubMedPubMedCentral

14.

Méry B, Falk AT, Assouline A, Trone JC, Guy JB, Rivoirard R, Auberdiac P, Escure JL, Moncharmont C, Moriceau G, Almokhles H, de Laroche G, Pacaut C, Guillot A, Chargari C, Magné N (2015) Hypofractionated radiation therapy for treatment of bladder carcinoma in patients aged 90 years and more: a new paradigm to be explored? Int Urol Nephrol 47:1129–1134CrossRefPubMed

15.

Vallard A, Rancoule C, Guy JB, Assouline A, Falk AT, Auberdiac P, Langrand-Escure J, Chargari C, Magné N (2017) Radiotherapy among nonagenarians with anal or rectal carcinoma: should we avoid or adapt treatment? Chin J Cancer 36:56CrossRefPubMedPubMedCentral

16.

Oguchi M, Ikeda H, Watanabe T, Shikama N, Ohata T, Okazaki Y, Kiyono K, Sone S (1998) Experiences of 23 patients ≥ 90 years of age treated with radiation therapy. Int J Radiat Oncol Biol Phys 41:407–413CrossRefPubMed

17.

Videtic GMM, Woody NM, Reddy CA, Stephans KL (2017) Never too old: a single-institution experience of stereotactic body radiation therapy for patients 90 years and older with early stage lung cancer. Pract Radiat Oncol. https://doi.org/10.1016/j.prro.2017.06.011 CrossRefPubMed

18.

Spyropoulou D, Pallis AG, Leotsinidis M, Kardamakis D (2014) Completion of radiotherapy is associated with the Vulnerable Elders Survey-13 score in elderly patients with cancer. J Geriatr Oncol 5:20–25CrossRefPubMed

19.

Shahrokni A, Kim SJ, Bosl GJ, Korc-Grodzicki B (2017) How we care for an older patient with cancer. J Oncol Pract 13:95–102CrossRefPubMedPubMedCentral

20.

Somasundar P, Mourey L, Lozza L, Maggi S, Stepney R (2017) Advances in geriatric oncology: a multidisciplinary perspective. Tumori. https://doi.org/10.5301/tj.5000661 CrossRef

21.

Li D, Soto-Perez-de-Celis E, Hurria A (2017) Geriatric assessment and tools for predicting treatment toxicity in older adults with cancer. Cancer J 23:206–210CrossRefPubMed

22.

Ethun CG, Bilen MA, Jani AB, Maithel SK, Ogan K, Master VA (2017) Frailty and cancer: implications for oncology surgery, medical oncology, and radiation oncology. Ca Cancer J Clin 67:362–377CrossRefPubMed

23.

Kirkhus L, Šaltytė Benth J, Rostoft S, Grønberg BH, Hjermstad MJ, Selbæk G, Wyller TB, Harneshaug M, Jordhøy MS (2017) Geriatric assessment is superior to oncologists’ clinical judgement in identifying frailty. Br J Cancer 117:470–477CrossRefPubMedPubMedCentral

24.

Takahashi M, Takahashi M, Komine K, Yamada H, Kasahara Y, Chikamatsu S, Okita A, Ito S, Ouchi K, Okada Y, Imai H, Saijo K, Shirota H, Takahashi S, Mori T, Shimodaira H, Ishioka C (2017) The G8 screening tool enhances prognostic value to ECOG performance status in elderly cancer patients: a retrospective, single institutional study. PLoS ONE 12:e179694CrossRefPubMedPubMedCentral

25.

Osborne GEC, Appleyard SA, Gilbert DC, Jones CI, Lorimer C, Villanueva M, Peasgood E, Robinson A, Nikapota A, Ring A (2017) Comprehensive geriatric assessment in men aged 70 years or older with localised prostate cancer undergoing radical radiotherapy. Clin Oncol (R Coll Radiol) 29:609–616CrossRef

26.

Ommundsen N, Wyller TB, Nesbakken A et al (2014) Frailty is an independent predictor of survival in older patients with colorectal cancer. Oncologist 19(12):1268–1275. https://doi.org/10.1634/theoncologist.2014-0237 CrossRefPubMedPubMedCentral

27.

Ghebre RG, Posthuma R, Vogel RI, Geller MA, Carson LF (2011) Effect of age and comorbidity on the treatment and survival of older patients with vulvar cancer. Gynecol Oncol 121(3):595–599. https://doi.org/10.1016/j.ygyno.2011.02.005 CrossRefPubMedPubMedCentral

28.

Jatoi A, Muss H, Allred JB et al (2016) Social support and its implications in older, early-stage breast cancer patients in CALGB 49907 (alliance A171301). Psychooncology 25(4):441–446. https://doi.org/10.1002/pon.3850 CrossRefPubMed

29.

Aizer AA, Chen M‑H, McCarthy EP et al (2013) Marital status and survival in patients with cancer. J Clin Oncol 31(31):3869–3876. https://doi.org/10.1200/JCO.2013.49.6489 CrossRefPubMedPubMedCentral

30.

Apariio T, Jouve JL, Teillet L et al (2013) Geriatric factors predict chemotherapy feasibility: ancillary results of FFCD 2001-02 phase III study in first-line chemotherapy for metastatic colorectal cancer in elderly patients. J Clin Oncol 31(11):1464–1470. https://doi.org/10.1200/JCO.2012.42.9894 CrossRef

Title: Feasibility of radiotherapy in nonagenarian patients: a retrospective study
Authors: L. Kocik
H. Geinitz
C. Track
M. Geier
C. Nieder
Publication date: 01-01-2019
Publisher: Springer Berlin Heidelberg
Published in: Strahlentherapie und Onkologie / Issue 1/2019
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-018-1355-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Feasibility of radiotherapy in nonagenarian patients: a retrospective study

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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