Abstract
ObjectiveTo determine the effect of age on completion of and toxicities following treatment of local regionally advanced cervical cancer (LACC) on Gynecologic Oncology Group (GOG) Phase I–III trials. MethodsAn ancillary data analysis of GOG protocols 113, 120, 165, 219 data was performed. Wilcoxon, Pearson, and Kruskal-Wallis tests were used for univariate and multivariate analysis. Log rank tests were used to compare survival lengths. ResultsOne-thousand-three-hundred-nineteen women were included; 60.7% were Caucasian, 15% were age 60–70years and an additional 5% were >70; 87% had squamous histology, 55% had stage IIB disease and 34% had IIIB disease. Performance status declined with age (p=0.006). Histology and tumor stage did not significantly differ.Number of cycles of chemotherapy received, radiation treatment time, nor dose modifications varied with age. Notably, radiation protocol deviations and failure to complete brachytherapy (BT) did increase with age (p=0.022 and p<0.001 respectively).Only all grade lymphatic (p=0.006) and grade≥3 cardiovascular toxicities (p=0.019) were found to vary with age.A 2% increase in the risk of death for every year increase >50 for all-cause mortality (HR 1.02; 95% CI, 1.01–1.04) was found, but no association between age and disease specific mortality was found. ConclusionThis represents a large analysis of patients treated for LACC with chemo/radiation, approximately 20% of whom were >60years of age. Older patients, had higher rates of incomplete brachytherapy which is not explained by collected toxicity data. Age did not adversely impact completion of chemotherapy and radiation or toxicities.
Highlights
The older population, typically defined as persons 65 years or older, numbered 39.6 million in 2009 and represented 13% of the U.S population [1]
According to the American Cancer Society, it is estimated that 12,990 women will be diagnosed with cervical cancer and 4120 women will die from their disease in 2016 [2]
The overall incidence of cervical cancer has declined since the introduction of regular cervical screening guidelines, the proportion of older women being diagnosed with the disease has increased
Summary
The older population, typically defined as persons 65 years or older, numbered 39.6 million in 2009 and represented 13% of the U.S population [1]. It is estimated that by 2030 there will be approximately 72 million older persons, more than twice their number in 2000, and persons age 65 and older are expected to represent 19% of the population [1]. In 2007, the incidence rate of cervical cancer for women greater than age 50 was 10.3 per 100,000 compared to 5.1 per 100,000 for those younger than 50 [3]. This is not unexpected given that cervical cancer is bimodal in its age related distribution with peaks between the ages of 30–39 and a second peak from 60 to 69 [4]
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