Abstract
Simple SummaryAs population ages, understanding of frailty in cancer patients becomes all the more important. Due to the rarity of elderly patients in randomized prospective trials, only limited data exist regarding safety and feasibility of postoperative radiotherapy for very elderly women of 80 years or older in a curative treatment intent. Further, geriatric assessments and prognostic scores for these women are not sufficiently validated. In a homogenous cohort of very elderly women with endometrial cancer, we confirmed that, despite older age, adjuvant radiotherapy can achieve excellent local control and overall survival with minimal high-grade toxicity. The geriatric G8 screening score was a highly applicable tool for prognostic evaluation of overall survival in our review.Endometrial cancer is a common malignancy in elderly women that are more likely to suffer from limiting medical comorbidities. Given this narrower therapeutic ratio, we aimed to assess the oncologic outcomes and toxicity in the adjuvant setting. Out of a cohort of 975 women, seventy patients aged ≥ 80 years, treated with curative postoperative radiotherapy (RT) for endometrial cancer between 2005 and 2021, were identified. Outcomes were assessed using Kaplan–Meier-analysis and comorbidities using the Charlson Comorbidity Index and G8 geriatric score. The overall survival at 1-, 2- and 5-years was 94.4%, 82.6%, and 67.6%, respectively, with significant correlation to G8 score. At 1- and 5-years, the local control rates were 89.5% and 89.5% and distant control rates were 86.3% and 66.9%, respectively. Severe (≥grade 3) acute toxicity was rare with gastrointestinal (2.9%), genitourinary (1.4%), and vaginal disorders (1.4%). Univariate analysis significantly revealed inferior overall survival with lower RT dose, G8 score, hemoglobin levels and obesity, while higher grading, lymphangiosis, RT dose decrease and the omission of chemotherapy reduced distant control. Despite older age and additional comorbidities, elderly patients tolerated curative treatment well. The vast majority completed treatment as planned with very low rates of acute severe side-effects. RT offers durable local control; however, late distant failure remains an issue.
Highlights
Endometrial cancer (EC) represents the fourth most common cancer in women in the United States with a rising incidence and a mean age at diagnosis of 68 years [1,2]
Endometrial cancer is a common malignancy in elderly women that are more likely to suffer from limiting medical comorbidities
Out of a sample of 975 women, who were treated with curative, postoperative RT following surgical resection for EC between March 2005 and June 2021 at our Department of Radiation Oncology of Heidelberg University Hospital, we included a subset of women aged ≥ 80 years
Summary
Endometrial cancer (EC) represents the fourth most common cancer in women in the United States with a rising incidence and a mean age at diagnosis of 68 years [1,2]. The most common clinical presentation is postmenopausal bleeding which is typically evaluated by transvaginal ultrasound and subsequent endometrial sampling [6,7]. Pathological classification originally emerged from two classical phenotypes and includes Type I which is closely linked to aforementioned metabolic components, and Type 2 representing a higher risk cohort with poor differentiation and inferior clinical outcome [8]. Correlations of these two types with histologic patterns have been defined with the most common variants being endometrioid adenocarcinoma, serous and clear-cell carcinoma, and carcinosarcoma [9,10]. Staging follows the classification of the International Federation of Gynecology and Obstetrics (FIGO) Cancer Report [11] and corresponding TNM classification
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
