Definitive chemoradiotherapy for advanced cervical cancer: should it be different in the elderly?

Caires, Inacelli Queiroz de Souza; Souza, Karla Teixeira; Negrão, Marcelo V.; Oliveira, Juliana Gomes Ramalho de; Barroso‐Sousa, Romualdo; Lima, Rafael Caires Alvino de; Hoff, Paulo M.; Estevez-Diz, Maria Del Pilar

doi:10.1016/j.ejogrb.2015.05.007

Cited by 8 publications

(14 citation statements)

References 21 publications

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“…This group has been poorly studied in clinical trials and under treated based on population bases data. This has been attributed to multiple factors including physician bias, presence of multiple medical co-morbidities and a belief that elderly patients are more vulnerable and prone to toxicity [4, 7, 23]. The GOG launched a registration trial known as GOG-247, which was a prospective, multi-institutional observational trial evaluating baseline characteristics of patients who presented with treatment naïve cervical or uterine cancer and how these factors impact enrollment on a clinical trial.…”

Section: Discussionmentioning

confidence: 99%

Is age a prognostic biomarker for survival among women with locally advanced cervical cancer treated with chemoradiation? An NRG Oncology/Gynecologic Oncology Group ancillary data analysis

Moore

Java

Slaughter

et al. 2016

Gynecologic Oncology

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Objective To determine the effect of age on completion of and toxicities following treatment of local regionally advanced cervical cancer (LACC) on Gynecologic Oncology Group (GOG) Phase I–III trials. Methods An ancillary data analysis of GOG protocols 113, 120, 165, 219 data was performed. Wilcoxon, Pearson, and Kruskal-Wallis tests were used for univariate and multivariate analysis. Log rank tests were used to compare survival lengths. Results One-thousand-three-hundred-nineteen women were included; 60.7% were Caucasian, 15% were age 60–70 years and an additional 5% were >70; 87% had squamous histology, 55% had stage IIB disease and 34% had IIIB disease. Performance status declined with age (p = 0.006). Histology and tumor stage did not significantly differ. Number of cycles of chemotherapy received, radiation treatment time, nor dose modifications varied with age. Notably, radiation protocol deviations and failure to complete brachytherapy (BT) did increase with age (p = 0.022 and p < 0.001 respectively). Only all grade lymphatic (p = 0.006) and grade ≥3 cardiovascular toxicities (p= 0.019) were found to vary with age. A 2% increase in the risk of death for every year increase >50 for all-cause mortality (HR 1.02; 95% CI, 1.01–1.04) was found, but no association between age and disease specific mortality was found. Conclusion This represents a large analysis of patients treated for LACC with chemo/radiation, approximately 20% of whom were >60 years of age. Older patients, had higher rates of incomplete brachytherapy which is not explained by collected toxicity data. Age did not adversely impact completion of chemotherapy and radiation or toxicities.

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Section: Discussionmentioning

confidence: 99%

Is age a prognostic biomarker for survival among women with locally advanced cervical cancer treated with chemoradiation? An NRG Oncology/Gynecologic Oncology Group ancillary data analysis

Moore

Java

Slaughter

et al. 2016

Gynecologic Oncology

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“…21 In previous studies, the rates of elderly patients with LACC treated with RT alone varied from 36% to 67% depending on the definition of 'elder' (cut-off age) and study period. 11,12 Our study found that about half of patients were treated with RT alone.…”

Section: Discussionmentioning

confidence: 86%

“…28 Although CCRT with cisplatin remains the standard treatment of patients with LACC, elders in previous clinical trials represented less than 10% of all study populations and no subgroup analyses in elders have been reported [6][7][8][9][10] ; however, previously limited number of retrospective studies showed CCRT providing better oncological outcomes than RT alone. 11,12,14 A multicentre study by Guler et al, 13 which assessed 269 elderly cervical cancer patients treated with radiotherapy between 2001 and 2013, found CCRT associated with improved OS and disease-free survival (DFS). A recent study undertaken in China compared the efficacy and tolerance of radical RT and CCRT in 73 elderly LACC patients (≥70 years old) and found that elderly cervical cancer patients could tolerate both radical RT and CCRT very well with favourable survival outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7][8][9][10] Even in elderly patients, a few retrospective studies have found that CCRT showed better oncological outcomes than treatment with radiotherapy (RT) alone. [11][12][13][14] Other studies reported that the completion of a CCRT protocol significantly improved local control and prolonged survival in both young and elderly patients. [15][16][17][18] However, the combination of chemotherapy (CMT) and RT raises toxicity; therefore, some patients cannot complete a full course of CCRT, especially elderly patients who are more likely to suffer from weakness and comorbidities.…”

Section: Introductionmentioning

confidence: 99%

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Impact of chemotherapy cycles on oncological outcomes in elders with locally advanced cervical cancer treated with concurrent chemoradiotherapy

et al. 2022

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Introduction To investigate the association between chemotherapy (CMT) cycles and oncological outcomes in elders with locally advanced cervical cancer (LACC) who treated with concurrent chemoradiotherapy (CCRT). Methods We retrospective studied 498 elders with LACC who treated with radiotherapy (RT) or CCRT between 2002 and 2018. Patients were divided into three groups: RT, CCRT with 1–4 and CCRT with 5–6 cycles of CMT. We compared progression‐free survival (PFS) and overall survival (OS) among the three groups and explored survival prognostic factors via multivariate analysis and time‐varying analysis effect. Results There were 453 eligible patients; 222, 119 and 112 patients who received RT, CCRT with 1–4 and CCRT with 5–6 cycles of CMT, respectively. Patients in the RT group had older age, poorer performance status, more treatment with conventional RT technique and earlier treatment year comparing with both CCRT groups. Patients who received 5–6 cycles of CMT were less to have underweight, comorbidities and anaemia compared with the RT group. There were patients with lower FIGO stage in 5–6 cycles than in 1–4 cycles of CMT and RT groups. The 5‐year PFS and OS between RT, CCRT with 1–4 and CCRT with 5–6 cycles of the CMT group were significantly different. Performance status, comorbidity, histology, FIGO stage and total received 5–6 CMT cycles were significant prognostic factors of PFS and OS. However, the benefits of receiving 5–6 CMT cycles were evidenced only within the first 2.5 years. Conclusion Elders with LACC who received 5–6 cycles of CMT concurrently with RT can improve PFS and OS, but the benefit persisted only within the first 2.5 years.

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“…Older patients are more exposed to adverse events, such as renal failure, vomiting, proctitis, cystitis, or denutrition, reflecting frailty. However, other retrospective studies claimed that radiochemotherapy is well tolerated and effective in these older populations, but with wrong definition of 'elderly' (i.e., over 60 or 65 years old) [19][20][21]. Eventually, none of these studies used scales to assess specific outcomes in this geriatric population, precluding solid recommendations regarding radiochemotherapy on older patients.…”

Section: Discussionmentioning

confidence: 99%

Are Older Patients with Cervical Cancer Managed Differently to Younger Patients? An International Survey

Frélaut

Glas

Zapardiel

et al. 2019

Cancers

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Although a quarter of cervical cancers occur after the age of 65 years, there is no treatment consensus for these patients. The aim of this work was to survey how physicians treat patients with advanced cervical cancer, focusing on treatment adjustments according to age and frailty status. Specialists were invited to an online survey. Data collected included information on respondent and treatment strategy in four cases (FIGO IIb, FIGO IVa, FIGO IVb, metastatic recurrence) with three age scenarios (45-year-old, 75-year-old and fit, 75-year-old and unfit). We received 237 responses of which 117 were fully completed. Thirty-four percent of respondents reported they had available access to a geriatric team and 25% used a frailty screening tool in routine. Therapeutic strategies did not differ between young and old fit patients. However, treatment modalities and intensity were different for old and unfit patients. Physicians answered that they would treat old fit patients as their younger counterparts but would reduce treatment intensity for old unfit patients. However, even if they were willing to adapt their treatment strategy based on frailty status, most of them do not use the tools that would allow distinguishing “fit” and “unfit” older patients, leaving room for improving accurate geriatric evaluation.

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Definitive chemoradiotherapy for advanced cervical cancer: should it be different in the elderly?

Cited by 8 publications

References 21 publications

Is age a prognostic biomarker for survival among women with locally advanced cervical cancer treated with chemoradiation? An NRG Oncology/Gynecologic Oncology Group ancillary data analysis

Is age a prognostic biomarker for survival among women with locally advanced cervical cancer treated with chemoradiation? An NRG Oncology/Gynecologic Oncology Group ancillary data analysis

Impact of chemotherapy cycles on oncological outcomes in elders with locally advanced cervical cancer treated with concurrent chemoradiotherapy

Are Older Patients with Cervical Cancer Managed Differently to Younger Patients? An International Survey

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