Skip to main content
Top
Published in: Archives of Gynecology and Obstetrics 4/2011

Open Access 01-10-2011 | Gynecologic Oncology

Radiotherapy for Japanese elderly patients with cervical cancer: preliminary survival outcomes and evaluation of treatment-related toxicity

Authors: Kenji Yoshida, Ryohei Sasaki, Hideki Nishimura, Daisuke Miyawaki, Tetsuya Kawabe, Yoshiaki Okamoto, Koji Nakabayashi, Shigeki Yoshida, Kazuro Sugimura

Published in: Archives of Gynecology and Obstetrics | Issue 4/2011

Login to get access

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.
Literature
2.
3.
go back to reference Yang L, Fujimoto J, Qiu D, Sakamoto N (2009) Trends in cancer mortality in Japanese adolescents and young adults aged 15–29 years, 1970–2006. Ann Oncol 20:758–766PubMedCrossRef Yang L, Fujimoto J, Qiu D, Sakamoto N (2009) Trends in cancer mortality in Japanese adolescents and young adults aged 15–29 years, 1970–2006. Ann Oncol 20:758–766PubMedCrossRef
4.
go back to reference Kokawa K, Takekida S, Kamiura S, Kita M, Enomoto T, Kawaguchi R, Saito J, Horie A, Umesaki N (2010) The incidence, treatment and prognosis of cervical carcinoma in young women: a retrospective analysis of 4, 975 cases in Japan. Eur J Gynaecol Oncol 31:37–43PubMed Kokawa K, Takekida S, Kamiura S, Kita M, Enomoto T, Kawaguchi R, Saito J, Horie A, Umesaki N (2010) The incidence, treatment and prognosis of cervical carcinoma in young women: a retrospective analysis of 4, 975 cases in Japan. Eur J Gynaecol Oncol 31:37–43PubMed
5.
go back to reference Landoni F, Maneo A, Colombo A, Placa F, Milani R, Perego P, Favini G, Ferri L, Mangioni C (1997) Randomised study of radical surgery versus radiotherapy for stage Ib-IIa cervical cancer. Lancet 350:535–540PubMedCrossRef Landoni F, Maneo A, Colombo A, Placa F, Milani R, Perego P, Favini G, Ferri L, Mangioni C (1997) Randomised study of radical surgery versus radiotherapy for stage Ib-IIa cervical cancer. Lancet 350:535–540PubMedCrossRef
6.
go back to reference Perez CA, Grigsby PW, Camel HM, Galakatos AE, Mutch D, Lockett MA (1995) Irradiation alone or combined with surgery in stage IB, IIA, and IIB carcinoma of uterine cervix: update of a nonrandomized comparison. Int J Radiat Oncol Biol Phys 31:703–716PubMedCrossRef Perez CA, Grigsby PW, Camel HM, Galakatos AE, Mutch D, Lockett MA (1995) Irradiation alone or combined with surgery in stage IB, IIA, and IIB carcinoma of uterine cervix: update of a nonrandomized comparison. Int J Radiat Oncol Biol Phys 31:703–716PubMedCrossRef
7.
go back to reference Gaze MN, Kelly CG, Dunlop PR, Redpath AT, Kerr GR, Cowie VJ (1992) Stage IB cervical carcinoma: a clinical audit. Br J Radiol 65:1018–1024PubMedCrossRef Gaze MN, Kelly CG, Dunlop PR, Redpath AT, Kerr GR, Cowie VJ (1992) Stage IB cervical carcinoma: a clinical audit. Br J Radiol 65:1018–1024PubMedCrossRef
8.
go back to reference Yamashita H, Nakagawa K, Tago M, Shiraishi K, Nakamura N, Ohtomo K, Oda K, Nakagawa S, Yasugi T, Taketani Y (2005) Comparison between conventional surgery and radiotherapy for FIGO stage I-II cervical carcinoma: a retrospective Japanese study. Gynecol Oncol 97:834–839PubMedCrossRef Yamashita H, Nakagawa K, Tago M, Shiraishi K, Nakamura N, Ohtomo K, Oda K, Nakagawa S, Yasugi T, Taketani Y (2005) Comparison between conventional surgery and radiotherapy for FIGO stage I-II cervical carcinoma: a retrospective Japanese study. Gynecol Oncol 97:834–839PubMedCrossRef
9.
go back to reference Undurraga M, Loubeyre P, Dubuisson JB, Schneider D, Petignat P (2010) Early-stage cervical cancer: is surgery better than radiotherapy? Expert Rev Anticancer Ther 10:451–460 (Review)PubMedCrossRef Undurraga M, Loubeyre P, Dubuisson JB, Schneider D, Petignat P (2010) Early-stage cervical cancer: is surgery better than radiotherapy? Expert Rev Anticancer Ther 10:451–460 (Review)PubMedCrossRef
10.
go back to reference Korfage IJ, Essink-Bot ML, Mols F, van de Poll-Franse L, Kruitwagen R, van Ballegooijen M (2009) Health-related quality of life in cervical cancer survivors: a population-based survey. Int J Radiat Oncol Biol Phys 73:1501–1509PubMedCrossRef Korfage IJ, Essink-Bot ML, Mols F, van de Poll-Franse L, Kruitwagen R, van Ballegooijen M (2009) Health-related quality of life in cervical cancer survivors: a population-based survey. Int J Radiat Oncol Biol Phys 73:1501–1509PubMedCrossRef
11.
go back to reference Frumovitz M, Sun CC, Schover LR, Munsell MF, Jhingran A, Wharton JT, Eifel P, Bevers TB, Levenback CF, Gershenson DM, Bodurka DC (2005) Quality of life and sexual functioning in cervical cancer survivors. J Clin Oncol 23:7428–7436PubMedCrossRef Frumovitz M, Sun CC, Schover LR, Munsell MF, Jhingran A, Wharton JT, Eifel P, Bevers TB, Levenback CF, Gershenson DM, Bodurka DC (2005) Quality of life and sexual functioning in cervical cancer survivors. J Clin Oncol 23:7428–7436PubMedCrossRef
12.
go back to reference Sakurai H, Mitsuhashi N, Takahashi M, Yamakawa M, Akimoto T, Hayakawa K, Niibe H (2000) Radiation therapy for elderly patient with squamous cell carcinoma of the cervix. Gynecol Oncol 77:116–120PubMedCrossRef Sakurai H, Mitsuhashi N, Takahashi M, Yamakawa M, Akimoto T, Hayakawa K, Niibe H (2000) Radiation therapy for elderly patient with squamous cell carcinoma of the cervix. Gynecol Oncol 77:116–120PubMedCrossRef
13.
go back to reference Ikushima H, Takegawa Y, Osaki K, Furutani S, Yamashita K, Kawanaka T, Kubo A, Kudoh T, Nishitani H (2007) Radiation therapy for cervical cancer in the elderly. Gynecol Oncol 107:339–343PubMedCrossRef Ikushima H, Takegawa Y, Osaki K, Furutani S, Yamashita K, Kawanaka T, Kubo A, Kudoh T, Nishitani H (2007) Radiation therapy for cervical cancer in the elderly. Gynecol Oncol 107:339–343PubMedCrossRef
15.
go back to reference International Commission on Radiation Units and Measurements (1985) Dose and volume specification for intracavity therapy in gynecology. ICRU report 38. ICRU, Washington International Commission on Radiation Units and Measurements (1985) Dose and volume specification for intracavity therapy in gynecology. ICRU report 38. ICRU, Washington
16.
go back to reference Common Toxicity Criteria version 4.0 Japanese Translation—JCOG (2009) Japan Clinical Oncology Group Common Toxicity Criteria version 4.0 Japanese Translation—JCOG (2009) Japan Clinical Oncology Group
17.
go back to reference Terret C, Albrand G, Droz JP (2004) Management and geriatric assessment of cancer in the elderly. Clin Prostate Cancer 2:236–240PubMed Terret C, Albrand G, Droz JP (2004) Management and geriatric assessment of cancer in the elderly. Clin Prostate Cancer 2:236–240PubMed
18.
go back to reference Sekine I, Yamamoto N, Kunitoh H, Ohe Y, Tamura T, Kodama T, Saijo N (2004) Treatment of small cell lung cancer in the elderly based on a critical literature review of clinical trials. Cancer Treat Rev 30:359–368PubMedCrossRef Sekine I, Yamamoto N, Kunitoh H, Ohe Y, Tamura T, Kodama T, Saijo N (2004) Treatment of small cell lung cancer in the elderly based on a critical literature review of clinical trials. Cancer Treat Rev 30:359–368PubMedCrossRef
19.
go back to reference Harlacher R, Füsgen I (2000) Geriatric assessment in the elderly cancer patient. J Cancer Res Clin Oncol 126:369–374PubMedCrossRef Harlacher R, Füsgen I (2000) Geriatric assessment in the elderly cancer patient. J Cancer Res Clin Oncol 126:369–374PubMedCrossRef
20.
go back to reference Yancik R, Havlik RJ, Wesley MN, Ries L, Long S, Rossi WK, Edwards BK (1996) Cancer and comorbidity in older patients: a descriptive profile. Ann Epidemiol 6:399–412PubMedCrossRef Yancik R, Havlik RJ, Wesley MN, Ries L, Long S, Rossi WK, Edwards BK (1996) Cancer and comorbidity in older patients: a descriptive profile. Ann Epidemiol 6:399–412PubMedCrossRef
21.
go back to reference Hurria A, Wong FL, Villaluna D, Bhatia S, Chung CT, Mortimer J, Hurvitz S, Naeim A (2008) Role of age and health in treatment recommendations for older adults with breast cancer: the perspective of oncologists and primary care providers. J Clin Oncol 26:5386–5392PubMedCrossRef Hurria A, Wong FL, Villaluna D, Bhatia S, Chung CT, Mortimer J, Hurvitz S, Naeim A (2008) Role of age and health in treatment recommendations for older adults with breast cancer: the perspective of oncologists and primary care providers. J Clin Oncol 26:5386–5392PubMedCrossRef
22.
go back to reference Mitchell PA, Waggoner S, Rotmensch J, Mundt AJ (1998) Cervical cancer in the elderly treated with radiation therapy. Gynecol Oncol 71:291–298PubMedCrossRef Mitchell PA, Waggoner S, Rotmensch J, Mundt AJ (1998) Cervical cancer in the elderly treated with radiation therapy. Gynecol Oncol 71:291–298PubMedCrossRef
23.
go back to reference Brun JL, Stoven-Camou D, Trouette R, Lopez M, Chene G, Hocké C (2003) Survival and prognosis of women with invasive cervical cancer according to age. Gynecol Oncol 91:395–401PubMedCrossRef Brun JL, Stoven-Camou D, Trouette R, Lopez M, Chene G, Hocké C (2003) Survival and prognosis of women with invasive cervical cancer according to age. Gynecol Oncol 91:395–401PubMedCrossRef
24.
go back to reference Wright JD, Gibb RK, Geevarghese S, Powell MA, Herzog TJ, Mutch DG, Grigsby PW, Gao F, Trinkaus KM, Rader JS (2005) Cervical carcinoma in the elderly: an analysis of patterns of care and outcome. Cancer 103:85–91PubMedCrossRef Wright JD, Gibb RK, Geevarghese S, Powell MA, Herzog TJ, Mutch DG, Grigsby PW, Gao F, Trinkaus KM, Rader JS (2005) Cervical carcinoma in the elderly: an analysis of patterns of care and outcome. Cancer 103:85–91PubMedCrossRef
25.
go back to reference de Rijke JM, van der Putten HW, Lutgens LC, Voogd AC, Kruitwagen RF, van Dijck JA, Schouten LJ (2002) Age-specific differences in treatment and survival of patients with cervical cancer in the southeast of The Netherlands, 1986–1996. Eur J Cancer 38:2041–2047PubMed de Rijke JM, van der Putten HW, Lutgens LC, Voogd AC, Kruitwagen RF, van Dijck JA, Schouten LJ (2002) Age-specific differences in treatment and survival of patients with cervical cancer in the southeast of The Netherlands, 1986–1996. Eur J Cancer 38:2041–2047PubMed
26.
go back to reference Chen SW, Liang JA, Yang SN, Lin FJ (2003) High dose-rate brachytherapy for elderly patients with uterine cervical cancer. Jpn J Clin Oncol 33:221–228PubMedCrossRef Chen SW, Liang JA, Yang SN, Lin FJ (2003) High dose-rate brachytherapy for elderly patients with uterine cervical cancer. Jpn J Clin Oncol 33:221–228PubMedCrossRef
27.
go back to reference Mitsuhashi N, Takahashi M, Nozaki M, Yamakawa M, Takahashi T, Sakurai H, Maebayashi K, Hayakawa K, Niibe H (1995) Squamous cell carcinoma of the uterine cervix: radiation therapy for patients aged 70 years and older. Radiology 194:141–145PubMed Mitsuhashi N, Takahashi M, Nozaki M, Yamakawa M, Takahashi T, Sakurai H, Maebayashi K, Hayakawa K, Niibe H (1995) Squamous cell carcinoma of the uterine cervix: radiation therapy for patients aged 70 years and older. Radiology 194:141–145PubMed
28.
go back to reference Lindegaard JC, Thranov IR, Endelholm SA (2000) Radiotherapy in the management of cervical cancer in elderly patients. Radiother Oncol 56:9–15PubMedCrossRef Lindegaard JC, Thranov IR, Endelholm SA (2000) Radiotherapy in the management of cervical cancer in elderly patients. Radiother Oncol 56:9–15PubMedCrossRef
29.
go back to reference Magné N, Mancy NC, Chajon E, Duvillard P, Pautier P, Castaigne D, Lhommé C, Morice P, Haie-Meder C (2009) Patterns of care and outcome in elderly cervical cancer patients: a special focus on brachytherapy. Radiother Oncol 91:197–201PubMedCrossRef Magné N, Mancy NC, Chajon E, Duvillard P, Pautier P, Castaigne D, Lhommé C, Morice P, Haie-Meder C (2009) Patterns of care and outcome in elderly cervical cancer patients: a special focus on brachytherapy. Radiother Oncol 91:197–201PubMedCrossRef
Metadata
Title
Radiotherapy for Japanese elderly patients with cervical cancer: preliminary survival outcomes and evaluation of treatment-related toxicity
Authors
Kenji Yoshida
Ryohei Sasaki
Hideki Nishimura
Daisuke Miyawaki
Tetsuya Kawabe
Yoshiaki Okamoto
Koji Nakabayashi
Shigeki Yoshida
Kazuro Sugimura
Publication date
01-10-2011
Publisher
Springer-Verlag
Published in
Archives of Gynecology and Obstetrics / Issue 4/2011
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI
https://doi.org/10.1007/s00404-010-1777-6

Other articles of this Issue 4/2011

Archives of Gynecology and Obstetrics 4/2011 Go to the issue