Department of Radiation Oncology, Ansan Hospital, College of Medicine, Korea University, 123 Jeokgeum street, 15355, Ansan, Gyeonggi-do, Korea (Republic of).
Department of Radiation Oncology, Guro Hospital, College of Medicine, Korea University, Seoul, Korea (Republic of).
Strahlenther Onkol. 2018 Oct;194(10):894-903. doi: 10.1007/s00066-018-1318-y. Epub 2018 May 24.
Although radiotherapy can be administered with a relatively low therapeutic burden, many elderly patients do not complete radiotherapy. In order to predict intolerance during radiotherapy, this study retrospectively analyzed the frequency of and risk factors for radiotherapy interruption among geriatric patients.
From September 2009 to December 2016, 353 patients aged ≥70 years received definitive radiotherapy with a conventionally fractionated schedule. "Total interruption" included completion of ≤90% of a planned radiotherapy, temporary discontinuation, and treatment-related mortality within 2 months. "Early-phase incompletion" and "mid-phase incompletion" represented completion of ≤50 and ≤80% of a planned radiotherapy, respectively.
The median age of patients was 74 years. Early- and mid-phase incompletions and total interruption occurred in 4.2, 9.3, and 19.3% of patients, respectively. Total interruption occurred frequently in cancers involving the thorax (27.4%), head and neck (23.1%), abdomen (20.0%), pelvis (17.4%), and breast/extremity (8.1%). The Eastern Cooperative Oncology Group (ECOG) performance score (P = 0.004 and 0.002), serum albumin level (P = 0.016 and 0.002), and the expected 5‑year survival (P = 0.033 and 0.034) were significant factors for mid-phase incompletion and total interruption. Age ≥ 75 years (P = 0.008), concurrent chemotherapy (P = 0.017), and the extent of radiation field (P = 0.027) were factors associated with total interruption.
Overall, 19.3% of the elderly patients showed treatment intolerance during conventional radiotherapy. Serum albumin level and ECOG performance score should be considered as surrogate markers for radiotherapy interruption prior to the decision regarding definite conventional radiotherapy.
尽管放疗的治疗负担相对较低，但许多老年患者无法完成放疗。为了预测放疗期间的不耐受，本研究回顾性分析了老年患者放疗中断的频率和危险因素。
2009 年 9 月至 2016 年 12 月，353 名年龄≥70 岁的患者接受了常规分割方案的根治性放疗。“总中断”包括完成计划放疗的≤90%、临时停药和 2 个月内与治疗相关的死亡。“早期阶段不完成”和“中期阶段不完成”分别代表完成计划放疗的≤50%和≤80%。
患者的中位年龄为 74 岁。早期和中期不完成以及总中断分别在 4.2%、9.3%和 19.3%的患者中发生。胸部（27.4%）、头颈部（23.1%）、腹部（20.0%）、骨盆（17.4%）和乳房/四肢（8.1%）的癌症中总中断发生率较高。东部合作肿瘤学组（ECOG）表现评分（P=0.004 和 0.002）、血清白蛋白水平（P=0.016 和 0.002）和预期的 5 年生存率（P=0.033 和 0.034）是中期不完成和总中断的显著因素。年龄≥75 岁（P=0.008）、同期化疗（P=0.017）和放疗野范围（P=0.027）是与总中断相关的因素。
总的来说，19.3%的老年患者在常规放疗期间表现出治疗不耐受。在决定进行确定性常规放疗之前，血清白蛋白水平和 ECOG 表现评分应被视为放疗中断的替代标志物。
