Palliative Radiotherapy for Nonagenarians: A 5-Year Retrospective Analysis

Abstract

Nonagenarians often present with advanced stage malignancies and complex prior treatment courses. Additionally, the fragility of this patient population can significantly limit surgical or systemic treatment options. Palliative radiotherapy is often offered in these challenging cases, however there is scarce data to help guide clinicians on which select patients may be most appropriate for radiotherapy versus other comfort care measures.A retrospective analysis was performed evaluating all patients from September 2015 to December 2020 who underwent palliative radiotherapy and were ≥ 90 years old at the time of initial treatment. Data pertaining to patient demographics, radiation course details, and survival outcomes were compiled and analyzed using descriptive statistics.35 patients were treated with palliative radiation therapy. Median age 92 (range 90-100). The median ECOG was 1 (range 0-4) and seven patients (20%) had an ECOG of 3-4. Only one patient (2.9%) had received radiotherapy prior to age 90 (8 Gy in 1 fraction). Median number of fractions for all courses was five fractions. Median follow up was 4.6 months. 17 patients (48.6%) presented with symptomatic distant metastases, including 16 for bone metastasis (94.1%) and one for painful right inguinal lymphadenopathy (37.5 Gy in 15 fractions). RT dose for osseous lesions included 6-8 Gy in 1 fraction (n = 10) and 20 Gy in 5 fractions (n = 6). The one month and three-month overall survival for distant palliation was 94.1% and 76.5%, respectively. Seven patients died, all due to their cancer. 18 patients (51.4%) underwent palliative radiotherapy for symptomatic local disease. Median RT dose was 30 Gy in 10 fractions (range, 8-45 Gy in 1-25 fractions). The most common primary anatomic site of progression was gastrointestinal (38.9%), including gastric (2), colorectal (4), and pancreatic (1) malignancies. 10 patients (55.5%) were Stage IV at presentation. Among the 8 patients with stage I-III cancer, four had irretractable gastrointestinal bleeding, three refused definitive treatment, and one presented with non-obstructive painful inoperable colon cancer. The one month and three-month overall survival was 72.2% and 61.1% for local palliation cohort. Six patients died of their cancer, while one patient died of cardiovascular comorbidities.Nonagenarians tolerate palliative radiotherapy for distant metastases and locally progressive disease with over 70% of all patients surviving at least three months. Despite their age, radiotherapy should continue to be considered as palliative treatment for nonagenarians.