Medical and Radiation Oncology, Hôpital d'Instruction des Armées du Val-de-Grâce, Paris, France.
Radiation Oncology, Institut de Cancérologie Lucien Neuwirth, Saint Priest en Jarez, France.
Eur J Cancer. 2014 May;50(8):1490-7. doi: 10.1016/j.ejca.2014.02.012. Epub 2014 Mar 7.
There are only scarce data on the management of patients aged 90years or older with cancer, and more particularly on the place of radiation therapy (RT). We report the first large study on patients (pts) aged 90years or older receiving RT.
Records from RT departments from five institutions were reviewed to identify pts 90years of age and older who underwent RT for various malignant tumours treated between 2003 and 2012. Tumours' characteristics were examined, as well as treatment specificities and treatment intent.
308 pts receiving 318 RT courses were identified, mean age was 93.2years (standard deviation 2.8). Treatment was given with curative and palliative intent in 44% and 56%, respectively. Factors associated with a curative treatment were performance status (PS), place of life, previous surgery and tumour stage. Median total prescribed dose was 36Gy (4-76Gy). Hypofractionation and split course were used in 88% and 7.3%, respectively. Most toxicities were mild to moderate. RT could not be completed in 23 pts (7.5%). No long-term toxicity was reported. Median overall survival was 22.9months (95CI: 15.5-42.7months). Cancer was the cause of death in 8.7% and 46% of pts treated with curative and palliative intent, respectively.
This study shows that RT is feasible for patients aged 90years or more. PS, place of life and tumour stage were factors of the therapeutic decision. There is no reason to withdraw pts with good general health condition from potentially curative RT, provided that careful attention is paid to factors of toxicity and to geriatric vulnerabilities.
仅有少量数据涉及 90 岁或以上老年癌症患者的治疗，特别是放射治疗（RT）的应用。我们报告了首个针对 90 岁或以上接受 RT 的患者的大型研究。
回顾了 5 家机构的放射治疗部门的记录，以确定 2003 年至 2012 年间因各种恶性肿瘤接受 RT 的 90 岁及以上患者。检查了肿瘤特征以及治疗的具体情况和治疗意图。
共确定了 308 名接受 318 次 RT 治疗的患者，平均年龄为 93.2 岁（标准差为 2.8）。分别有 44%和 56%的患者接受了根治性和姑息性治疗。与根治性治疗相关的因素包括体力状态（PS）、生活地点、既往手术和肿瘤分期。中位总规定剂量为 36Gy（4-76Gy）。分别有 88%和 7.3%的患者接受了低分割和分割治疗。大多数毒性反应为轻度至中度。有 23 名患者（7.5%）无法完成 RT。未报告长期毒性。中位总生存期为 22.9 个月（95%CI：15.5-42.7 个月）。接受根治性和姑息性治疗的患者中，癌症分别是 8.7%和 46%的死因。
本研究表明，90 岁或以上患者可进行 RT。PS、生活地点和肿瘤分期是治疗决策的因素。对于一般健康状况良好的患者，没有理由从潜在的根治性 RT 中退出，只要仔细注意毒性因素和老年脆弱性即可。
