Department of Medical Oncology, Hôpital Saint-André, Bordeaux University Hospital, Bordeaux, France.
Clin Interv Aging. 2013;8:433-42. doi: 10.2147/CIA.S30765. Epub 2013 Apr 19.
Both the aging population and the incidence of renal cell carcinoma (RCC) are growing, making the question of tumor management in the elderly a real challenge. Doctors should be aware of the importance of assessing this specific subpopulation. An aggressive therapeutic approach may be balanced by the benefit of the treatment - care or cure - and the life expectancy and willingness of the patient. The treatment for local disease can be surgery (radical or partial nephrectomy) or ablative therapies (radiofrequency, cryotherapy). Even if in most cases surgery is safe, complications such as alteration of renal function may occur, especially in the elderly, with physiological renal impairment at baseline. More recently, another option has been developed as an alternative: active surveillance. In the past decade, new drugs have been approved in the metastatic setting. All the phase 3 trials have included patients without a limit on age. Nevertheless, data concerning the elderly are still poor and concern only a very selective subpopulation. The toxicity profile of targeted agents may interfere with pre-existent comorbidities. Furthermore, the metabolism of several agents via cytochrome P450 can cause drug interaction. The importance of quality of life is a major factor with regard to management of therapy. Finally, to date, there is no recommendation of systematic a priori dose reduction in the elderly. In this review we describe the various possibilities of treatment for localized RCC or metastatic RCC in an aging population.
人口老龄化和肾细胞癌 (RCC) 的发病率都在增加，使得老年人群肿瘤管理问题成为一个真正的挑战。医生应该意识到评估这一特定亚群的重要性。积极的治疗方法可能需要平衡治疗的获益-护理或治愈-以及患者的预期寿命和意愿。局部疾病的治疗可以是手术（根治性或部分肾切除术）或消融治疗（射频、冷冻疗法）。尽管在大多数情况下手术是安全的，但可能会出现肾功能改变等并发症，尤其是在老年人中，基础肾功能已经受损。最近，另一种选择已经作为替代方案开发出来：主动监测。在过去十年中，新的药物已在转移性疾病中获得批准。所有的 3 期临床试验都纳入了无年龄限制的患者。然而，关于老年人的数据仍然很少，而且只涉及非常选择性的亚群。靶向药物的毒性特征可能会影响预先存在的合并症。此外，几种药物通过细胞色素 P450 代谢可能会导致药物相互作用。生活质量的重要性是治疗管理的一个主要因素。最后，迄今为止，对于老年患者，没有推荐系统性地预先减少剂量。在这篇综述中，我们描述了在老龄化人群中治疗局限性 RCC 或转移性 RCC 的各种可能性。
