Chau Brittney, LaGuardia Jonnby, Hui Caressa, Ye Linda, Xing Yan, Massarelli Erminia, Amini Arya
New York Medical College, School of Medicine, NY, USA.
University of Rochester, School of Medicine, NY, USA.
Transl Cancer Res. 2021 May;10(5):2620-2631. doi: 10.21037/tcr-20-2637.
Cancer is primarily a disease of the elderly, but there is a disproportionate lack of data from clinical trials in this population. Oncologists tend to underdiagnose and undertreat geriatric patients with cancer, leading to poor survival outcomes. New therapies or therapeutic combinations such as immunotherapy and stereotactic body radiation therapy (SBRT) can be used in the elderly for better tumor control and survival, with fewer toxicities. The aim of this review is to describe the synergistic effects of immunotherapy and radiation therapy (RT) and to discuss the use of these therapies concurrently and/or sequentially in the elderly. To gain a fuller picture of their elderly patient's health, physicians may also consider incorporating a comprehensive geriatric assessment (CGA) to evaluate their functional capacity, cognition, physical and mental health, and social supports which we will discuss in this review. It is recommended that oncologists use geriatric assessments in their everyday practice to have better insight on their complex elderly patients, therefore providing them a higher quality of care. They should also be incorporated in clinical trials as a way to assess and include more elderly patients in the study. Ultimately, the elderly deserve to be treated with more than their chronological age in mind, and new combination therapies and use of a geriatric assessment can help achieve that.
癌症主要是一种老年疾病，但针对这一人群的临床试验数据却极不成比例地匮乏。肿瘤学家往往对老年癌症患者诊断不足且治疗不够，导致生存结果不佳。新的疗法或治疗组合，如免疫疗法和立体定向体部放射疗法（SBRT），可用于老年患者，以更好地控制肿瘤并提高生存率，且毒性更小。本综述的目的是描述免疫疗法和放射疗法（RT）的协同作用，并讨论这些疗法在老年患者中同时和/或序贯使用的情况。为更全面地了解老年患者的健康状况，医生还可考虑采用综合老年评估（CGA）来评估其功能能力、认知、身心健康和社会支持，我们将在本综述中对此进行讨论。建议肿瘤学家在日常实践中使用老年评估，以便更好地了解其复杂的老年患者，从而为他们提供更高质量的护理。老年评估还应纳入临床试验，作为评估并纳入更多老年患者参与研究的一种方式。归根结底，老年患者理应得到超越其实际年龄的治疗，新的联合疗法和老年评估的应用有助于实现这一目标。
