Radiotherapy for gynecologic cancer in nonagenarian patients: a framework for new paradigms

Abstract

No consensus exists regarding the role of radiotherapy in the management of gynecologic cancer in nonagenarian patients. We retrospectively reviewed the outcomes of 19 consecutive nonagenarian patients with gynecologic cancer (6 endometrial cancers, 6 cervical cancers, 4 vulvar cancers, and 3 vaginal cancers) who were treated with radiotherapy. Radiotherapy was performed mainly in a palliative setting (n = 12; 63.2%), with a median dose of 45 Gy (range, 6–76 Gy). Infrequent major acute or late toxicities were reported. Among 19 patients, 9 (47.4%) experienced tumor progression, 5 (26.3%) experienced complete response, 2 (10.5%) experienced stable disease and/or partial response. At last follow-up, 12 patients (63.2%) had died; most deaths (n = 9) occurred because of the cancer. These results suggest that radiotherapy is feasible in the treatment of nonagenarian patients with gynecologic cancer.

Optimizing Palliative Pelvic Radiotherapy in Gynecological Cancers: A Systematic Review and Analysis

“…Furthermore, indications for therapeutic intervention were not limited solely to the primary presenting symptoms but also encompassed rectal and ureteral manifestations stemming from external pressure or localized invasion based on the malignancy. Interestingly, in certain cases, the treatments administered were not solely focused on relieving immediate symptoms but also aimed at locally controlling the tumor or hindering its progression [ 10 ]. This diversity in treatment goals and the spectrum of symptoms that were addressed highlights the multifaceted nature of symptomatology in gynecological cancers and underscores the complexity in managing these conditions comprehensively.…”

“…The heterogeneous nature of the treatments employed underscores the lack of standardized approaches in palliative radiotherapy used for gynecological cancers, necessitating further exploration and consensus to enhance treatment efficacy and patient outcomes. For example, the study by Benoîte Méry et al [ 10 ] comprises 19 patients (aged 90 to 98.6 years) treated with radical irradiation (likely employing a dose of 76 Gy in this subgroup), raising doubts about its applicability to the broader population of patients undergoing palliative radiotherapy. A careful consideration of such outliers is crucial in interpreting the findings and ensuring the generalizability of the systematic review’s conclusions.…”

Radiotherapy for nonagenarians: the value of biological versus chronological age

“…Whereas more and more studies have demonstrated both the feasibility and the effectiveness regarding radiotherapy for elderly patients, radiotherapy for patients aged ≥90 years is poorly studied in the literature [7][8][9][10]. Although there is a limited number of retrospective studies analyzing the treatment outcomes of radiotherapy for nonagenarian patients, evidence regarding radiotherapy for this patient group remains poor due to relatively low patient numbers in most of these studies [11][12][13][14][15][16][17][18][19][20].…”

Radiotherapy among nonagenarians with anal or rectal carcinoma: should we avoid or adapt treatment?

“…Because elderly patients are often excluded from clinical trials, little is known about radiotherapy’s therapeutic index (efficacy/toxicity ratio) in the geriatric population [ 1 ]. Still, the ageing of population imposes the challenge to treat older cancer patients and probably to adjust their treatment [ 2 ]. A few studies reported data on radiation-induced toxicities in nonagenarian patients, but data on efficacy are still scarce.…”