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Radiotherapy of the oldest old—feasibility and institutional analysis

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Abstract

Purpose

Little is known about efficacy and toxicity of radiation therapy in the elderly, as the vast majority of prospective trials excluded patients aged over 70 years. The aim of this study was to investigate the outcome of radiation therapy in a group of so-called oldest old cancer patients (≥85 years).

Materials and methods

We retrospectively reviewed data from patients aged ≥85 years, treated between 2010 and 2015 for any tumor histology at the University Hospital Zurich, Switzerland. Overall survival (OS), relapse-free survival (RFS), performance status (ECOG), Charlson comorbidity index (CCI) and treatment tolerance were assessed.

Results

We identified and included 100 patients with a mean age of 88 years (range: 85–102 years). Most patients received a curative-intent treatment (n = 64, 64%). About one third received palliative radiation therapy for symptomatic metastatic disease (n = 36, 36%). Curative treatment was well tolerated, with no high-grade acute toxicities (≥grade 4). Median OS was 52.6 and 13.1 months for the curative and palliative treated patient groups, respectively. 5‑year OS for all patients was 39.5% (95% CI: 23.6–54.5%). The Charlson comorbidity index (CCI) had a predictive value for overall survival (CCI > 10, p = 0.0001) in the curative group.

Conclusion

The number of older cancer patients will increase considerably in the next decades because of demographic changes. Our analysis supports the notion that radiation therapy for this patient group of oldest old cancer patients is feasible in general. Treatment decisions should not be based on chronological age but rather on comorbidities and functional status.

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Abbreviations

3D:

Three-dimensional

CCI:

Charlson comorbidity index

CF-3DRT:

Conformal three-dimensonal raiotherapy

CGA:

Comprehensive geriatric assessment

CI:

Confidence interval

CR:

Colorectal

CT:

Computer tomography

CTCAE:

Common Terminology Criteria for Adverse Events

ECOG PS:

Eastern Cooperative Oncology Group performance status

EORTC:

European Organization for Research and Treatment of Cancer

EQD2:

Equivalent dose of 2 Gy fractionation

ETF:

Elderly Task Force

GA:

Geriatric assessment

GI:

Gastrointestinal

IMRT:

Intensity-modulated radiation therapy

NIH:

National Institute on Aging and the National Institute of Health

OS:

Overall survival

RFS:

Relapse-free survival

RT:

Radiotherapy

VMAT:

Volumetric modulated arc therapy

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Authors and Affiliations

  1. Department of Radiation Oncology, University Hospital Zurich, Rämistraße 100, 8091, Zurich, Switzerland

    Eva-Maria Kretschmer, Matea Pavic, Luisa Sabrina Stark, Caroline Hertler & Matthias Guckenberger

Authors
  1. Eva-Maria Kretschmer
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  2. Matea Pavic
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  3. Luisa Sabrina Stark
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  4. Caroline Hertler
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  5. Matthias Guckenberger
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Corresponding author

Correspondence to Eva-Maria Kretschmer.

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Conflict of interest

E.-M. Kretschmer, M. Pavic, L.S. Stark, C. Hertler, and M. Guckenberger declare to have no competing interests.

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Kretschmer, EM., Pavic, M., Stark, L.S. et al. Radiotherapy of the oldest old—feasibility and institutional analysis. Strahlenther Onkol 196, 683–690 (2020). https://doi.org/10.1007/s00066-020-01621-z

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  • DOI: https://doi.org/10.1007/s00066-020-01621-z

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