O. Micke; Department of Radiotherapy and Radiation Oncology, Franziskus Hospital, Bielefeld, Germany
Purpose/Objective(s): There are only a few clinical data regarding radiotherapy (RT) in elderly patients’ populations. 60–70% of all cancers will develop in individuals aged 65 and over during this century. Aging is associated with physiological changes and comorbid illnesses, which may affect an individual tolerance to radiation. There is the belief that a relationship exists between age and radiation toxicity and therefore non-curative schemes are often offered to the elderly patients. Materials/
Methods: We performed a retrospective study of all patients aged 80 years and older who underwent RT with external beam irradiation in our institution in the years 2017 and 2023. A part of patients (57%) was assessed with a standardized Clinical Frailty Scale (CFS). Treatment outcome and morbidity were analyzed. Results: Overall, there were 267 cancer patients aged 80 and older treated with 296 courses of RT. The mean age of the study population was 86 years (range: 80–99 years). A total of 157 patients (59%) were male and 110 (41%) female. The treatment intent was palliative in 31% and curative in 69%. Overall, the prevalence of frailty was 43% in the study population. Primary cancer diagnoses were: prostate 66, lung 34, breast 47, head and neck 14, gastrointestinal 12, hematologic 11, gynecologic 19, skin 31, genitourinary 12, unknown primary 6, central nervous system 15. The patients were able to complete the prescribed therapy in 246 of 296 courses (83%). Treatment breaks during RT were only required in 68 (23%) of RT courses. Median overall survival was 50.8 and 12.3 months for the curative and palliative treated patient collectives, respectively. The 5-year overall survival for all patients was 34.2%. Frailty correlated strongly with overall prognosis, but also with RT outcome and treatment breaks. Conclusion: The number of older cancer patients will increase considerably in the next decades because of demographic changes. RT can be safely administered to an elderly population with both curative and palliative intent with the expectation of completion in more than 80% of patients. The reasons for inability to complete RT as prescribed are multifactorial, but careful patient selection and screening with CFS, and attention to comorbidity may optimize the outcome.
