Abstract
PurposeStandard treatment for early-stage endometrial cancer involves surgery (when possible) followed by brachytherapy or external-beam radiotherapy (EBRT) for high-risk tumors. EBRT is not without toxicity, meaning that it could be difficult to complete for elderly patients, who typically have decreased reserve and resistance to stressors.Patients and methodsPatients aged 70 and over treated between April 2009 and May 2013 for endometrial cancer and received IMRT (Intensity-Modulated Radiation Therapy) were included in this observational study. IMRT could be performed as adjuvant treatment or as an exclusive treatment for patients not amenable to surgery. The primary endpoints of this study were to assess the feasibility and toxicity of pelvic IMRT in this population. Secondary endpoints were to assess disease-specific survival, overall survival, and local control. Predictors of toxicity were also explored.ResultsForty seven consecutive patients were included in the analysis. Median age at diagnosis was 75 years (range, 70–89 years). Eleven patients were aged 80 years and older. Toxicities were found in thirty four patients (72%) during treatment. Among these, toxicity did not exceed grade 2 for 32 patients (68%). Two patients had a grade 3 toxicity (4%). Overall survival rates were 87% and 83% at 1 and 2 years, respectively. Six patients (12.8%) had a local relapse and nine others (19.1%) had distant relapse.ConclusionsPelvic helical IMRT for patients aged 70 and older is feasible with full standard radiation doses, showing that age greater than 70 should not be considered as a reason not to perform optimal treatment.
Highlights
Patients with endometrial cancer have a 95% 5-year specific survival rate when the disease is still localized
In a study published by Frick et al in 1973, old age was associated with shorter survival for patients with stage I disease who received the same treatment as others [5]
Patients treated between April 2009 and May 2013 for endometrial cancer and received Intensity-modulated radiation therapy (IMRT) were included in this observational study approved by our internal review board
Summary
Patients with endometrial cancer have a 95% 5-year specific survival rate when the disease is still localized. Old age [1], ethnicity [2], comorbidities [3], and anemia [4] are the main risk factors of poor prognosis. Creutzberg et al showed that age over 60 years was associated with a three-fold increased risk of local relapse (p50.003) and higher disease-specific mortality (p50.02) [7]. The poor prognosis associated with old age is found across all tumor types [8] and could be explained by the lack of guidelines for elderly patients due to the underrepresentation of this population in clinical trials [9]. As life expectancy rises and as the chance of developing endometrial cancer increases with age, oncologists are required to find new ways to manage elderly patients in order to close the survival gap seen between middle-aged and elderly patients
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