Basso Umberto, Tonti Singora, Bassi Catia, Brunello Antonella, Pasetto Lara Maria, Scaglione Daniela, Falci Cristina, Beda Manuela, Aversa Savina Maria Luciana, Stefani Micaela, Castegnaro Eugenio, Tamellini Fabio, Monfardini Silvio
Division of Medical Oncology, Istituto Oncologico Veneto-IOV IRCCS, Italy.
Crit Rev Oncol Hematol. 2008 May;66(2):163-70. doi: 10.1016/j.critrevonc.2007.12.006. Epub 2008 Feb 19.
To evaluate management and outcome of patients >or=70 years admitted to our Medical Oncology ward and evaluated by Multidimensional Geriatric Assessment before treatment with standard or "elderly-friendly" chemotherapy regimens, a list of which was developed within our Geriatric Oncology Program based on published clinical trials and personal experience.
Charts of patients treated from January 2004 to January 2006 were reviewed for choice of treatment, tumor response, toxicities and survival.
117 patients (median age 75 years) were divided into Frail (F) (34.2%) and Not-Frail patients (NF: 33.3% Fit plus 32.5% Vulnerable). The two groups did not differ according to the use of "elderly-friendly"chemotherapy regimens (40% of F pts and 39% of NF pts), dose reductions >or=25% (37.5% vs. 31.2%) and grade 3-4 toxicities (52.5% vs. 58.4%). Early interruption of treatment due to toxicity or patient's refusal (42.5 vs. 15.6, p=0.001) and deaths within 30 days from last chemotherapy administration (22.5% vs. 3.9%, p=0.003) were significantly different. F patients showed clinical or radiological response in 21.2% of cases, and subjective improvement in 22.6%. After a median follow-up of 19 months, median survival of F patients (6.4 months) is shorter compared to NF group (16.9 months, p=0.012).
The use of "elderly-friendly"chemotherapy regimens was limited to less than a half of cases. F patients may respond to chemotherapy but display higher rates of premature withdrawal and early deaths compared to NF patients, with a shorter survival. Clinical trials particularly aimed at frail patients are urgently needed.
评估年龄≥70岁且在我们的医学肿瘤病房住院，并在接受标准或“老年友好型”化疗方案治疗前接受多维老年评估的患者的管理情况和治疗结果，后者是我们老年肿瘤项目根据已发表的临床试验和个人经验制定的。
回顾2004年1月至2006年1月期间接受治疗的患者病历，以了解治疗选择、肿瘤反应、毒性和生存情况。
117例患者（中位年龄75岁）被分为虚弱组（F组，34.2%）和非虚弱组（NF组：33.3%健康组加32.5%脆弱组）。两组在使用“老年友好型”化疗方案（F组40%，NF组39%）、剂量减少≥25%（37.5%对31.2%）和3-4级毒性反应（52.5%对58.4%）方面无差异。因毒性或患者拒绝导致的治疗早期中断（42.5对15.6，p=0.001）以及最后一次化疗给药后30天内的死亡情况（22.5%对3.9%，p=0.003）存在显著差异。F组患者21.2%出现临床或影像学反应，22.6%有主观改善。中位随访19个月后，F组患者的中位生存期（6.4个月）短于NF组（16.9个月，p=0.012）。
“老年友好型”化疗方案的使用不到一半病例。F组患者可能对化疗有反应，但与NF组患者相比，过早停药和早期死亡的发生率更高，生存期更短。迫切需要专门针对虚弱患者的临床试验。
