Impact of Geriatric Assessment on Radiotherapy Intensity in Older Patients With Nonmetastatic Cancer: A Multi-institutional Study.

AIMS

This study prospectively investigated an appropriate geriatric assessment tool for predicting the decisions by radiation oncologists to reduce radiotherapy intensity.

MATERIALS AND METHODS

We enrolled patients with nonmetastatic cancer (aged ≥70 years) in this multicenter study. Reduced-intensity radiotherapy implied changes to the irradiation field and/or radiotherapy schedule from the standard based on the primary tumour guidelines. Geriatric assessment was performed by calculating the Geriatric 8 (G8) and Vulnerable Elders Survey (VES-13) scores before radiotherapy and at 3 to 5 and 8 to 16 weeks post radiotherapy. The primary endpoint was to evaluate the correlation between vulnerability, assessed by G8 score, and changes in radiation intensity.

RESULTS

Between November 2020 and February 2022, 317 patients from 13 centres in Japan were included in this study. The median patient age was 77 years (range: 70-90 years). The primary cancer sites were the head and neck and oesophagus, lungs, breasts, pancreas, bladder, uterus, and prostate in 63 and 22, 62, 48, 6, 5, 26, and 85 patients, respectively. Reduced intensity of radiotherapy was administered to 31 patients (10%); planned radiotherapy was completed in 312 patients (98%). High-precision radiotherapy was administered to 199 patients (63%). The treatment policy was modified in 87 patients (27%). Among these, 77 patients (89%) underwent a reduction in the intensity of concurrent chemotherapy. Grade 3 or higher acute adverse events were observed in 48 patients (15%), with 26 (54%) requiring inpatient treatment. Before radiotherapy, vulnerability was found in 201 (63.4%) and 61 (19.2%) patients based on G8 and VES-13 assessments, respectively. A multivariate analysis revealed that a reduction in radiation intensity was significantly associated with vulnerability assessed using the VES-13 score (P = 0.03) but not the G8 score (P = 0.63).

CONCLUSION

Geriatric assessment by the G8 score did not predict a reduction in radiation intensity or incompletion in older patients with cancer.