Huguenin P, Glanzmann C, Lütolf U M
Department of Radiation Oncology, University Hospital, Zurich, Switzerland.
Strahlenther Onkol. 1996 Dec;172(12):658-63.
One reason for obvious differences in cancer treatment of elderly patients, compared to younger patients, may be the fear of reduced tolerance at a higher age. The purpose of the study was to document acute tolerance of radiotherapy with curative intent in patients > 74 years old. Special emphasis was given to 72 patients treated to large volumes and/or high doses for gynecological carcinomas, prostate cancer of subsites of the head and neck requiring bilateral treatment of the neck including major parts of the pharynx and larynx.
From January 1991 to May 1995, 210 consecutive patients entered a prospective study to assess acute toxicity of radiotherapy given with curative intent. Median age was 79.3 (74.4 to 93.7) years. Fifty-three percent received postoperative radiotherapy, 47% radiotherapy alone. Radiation technique, fractionation and doses were the same as applied in younger patients. Tolerance was scored using a 5-point scale; in addition, pre- and post-treatment Karnofsky performance status and body weight were assessed.
Acute toxicity leads to a dose reduction in 3 patients. The death of 1 patient with Hodgkin's disease was attributable to large field radiotherapy, and 1 case of grade 4 cystitis was noted in a patient with prostate cancer. Radiotherapy for breast cancer with or without lymph nodes imposed no problem. With appropriate supportive measures, even hyperfractionated or accelerated radiotherapy regimens for carcinomas of the head and neck were feasible in elderly patients. Radiotherapy to the pelvic region lead to severe diarrhea requiring medication in 20% of the patients. For all areas treated, higher age within the range of > 74 to < 94 years did not increase the severity of the acute radiation reactions.
Using the same treatment schedules and techniques of radiotherapy as for younger patients, curative radiotherapy is well tolerated in patients aged > 74 years treated even when major parts of the pharynx and larynx or large volumes of the pelvis are included. Small bowel reaction (diarrhea) and pharyngeal mucositis deserve special attention and supportive care in elderly patients prone to a rapidly symptomatic dehydration.
与年轻患者相比，老年患者癌症治疗存在明显差异的一个原因可能是担心高龄时耐受性降低。本研究的目的是记录74岁以上患者根治性放疗的急性耐受性。特别关注了72例因妇科癌症、头颈部亚部位前列腺癌接受大体积和/或高剂量放疗的患者，这些癌症需要双侧颈部治疗，包括咽和喉的主要部分。
1991年1月至1995年5月，210例连续患者进入一项前瞻性研究，以评估根治性放疗的急性毒性。中位年龄为79.3（74.4至93.7）岁。53%的患者接受了术后放疗，47%的患者仅接受放疗。放疗技术、分割方式和剂量与年轻患者相同。使用5分制对耐受性进行评分；此外，还评估了治疗前后的卡氏功能状态和体重。
3例患者因急性毒性导致剂量减少。1例霍奇金病患者死亡归因于大野放疗，1例前列腺癌患者出现4级膀胱炎。乳腺癌无论有无淋巴结转移，放疗均无问题。通过适当的支持措施，老年患者对头颈部癌症进行超分割或加速放疗方案也是可行的。盆腔放疗导致20%的患者出现严重腹泻，需要药物治疗。对于所有治疗区域，74岁至94岁范围内年龄较大的患者并未增加急性放射反应的严重程度。
采用与年轻患者相同的放疗治疗方案和技术，即使包括咽和喉的主要部分或大量盆腔区域，74岁以上患者接受根治性放疗的耐受性良好。小肠反应（腹泻）和咽部粘膜炎在容易迅速出现症状性脱水的老年患者中值得特别关注和支持性护理。
