Elderly Cervical Cancer Patients Research Articles

Hyperproteinemia, Hematuria, and Squamous Cell Shedding in Elderly Cervical Cancer Patients and the Potential Alternative Screening Tool.

In Saudi Arabia, cervical cancer, frequently caused by human papillomavirus (HPV) infection, is a common cancer. The usual procedures for screening and diagnosing cervical cancer include Pap smears and HPV tests, even though they have considerable drawbacks, particularly for older women (> 60 years) who have limited access to or compliance with these tests. Urinalysis is a simple, noninvasive test that has been suggested as an alternative procedure. This study aimed to investigate the change in urinalysis characteristics in cervical cancer patients in elderly females and the possible use of urinalysis as a screening or diagnostic tool for cervical cancer in older women. This was an exploratory cross-sectional study of 190 cervical cancer patients diagnosed between January 2018 and August 2021. Based on age, the study included two groups, < 60 years and ≥ 60 years. Urinalysis characteristics, including bacterial count, blood level, protein level, and squamous epithelial cell shedding, were compared between the age groups by using the chi-squared and Kruskal-Walli tests. The results showed a significant difference between aged females and younger females with cervical cancer at the blood level, protein level, and squamous epithelial cell shedding in the urine. The older women (≥ 60 years) had higher incidences of increased bacterial count, blood levels, protein levels, and squamous epithelial cell shedding than the younger women (< 60 years). The main finding of the study implies that there are significant changes in urine characteristics in cervical cancer patients including hyperproteinemia, hematuria, and squamous cell shedding in elderly patients compared to younger patients, and it proposes a potential role for urinalysis as a screening tool for cervical cancer in older women. Urinalysis could be a potential screening tool for cervical cancer in older women who have not been screened or have no screening access. Further studies are needed to validate these findings.

Comparison of oncological outcomes in elderly early-stage cervical cancer patients treated with radical surgery or radiotherapy: A real-world retrospective study with propensity score matching.

To compare the oncological outcomes of radical surgery and radical radiotherapy in elderly (over 65 years) patients with early-stage cervical cancer (IB-IIA). Elderly patients with stage IB-IIA cervical cancer treated at Peking Union Medical College Hospital from January 2000 to December 2020 were retrospectively reviewed. All patients were divided into the radiotherapy group (RT group) and the operation group (OP group) according to their primary intervention. Propensity score matching (PSM) analysis was performed to balance the biases. The primary outcome was overall survival (OS), and the secondary outcomes were progression-free survival (PFS) and adverse effects. A total of 116 patients were eligible for the study (47 in the RT group, and 69 in the OP group), and after PSM, 82 patients were suitable for further analysis (37 in the RT group, and 45 in the OP group). In the real-world setting, it was found that compared with radiotherapy, operation was more frequently selected for elderly cervical cancer patients with adenocarcinoma (P < 0.001) and IB1 stage cancer (P < 0.001). The 5-year PFS rates between the RT and OP groups were not significant (82.3% vs. 73.6%, P = 0.659), and the 5-year OS rate of the OP group was significantly better than that in the RT group (100% vs. 76.3%, P = 0.039), especially in patients with squamous cell carcinoma (P = 0.029) and tumor size of 2~4 cm with G2 differentiation (P = 0.046). There was no significant difference in PFS between the two groups (P = 0.659). In the multivariate analysis, compared with operation, radical radiotherapy was an independent risk factor of OS (hazard ratio = 4.970, 95% CI, 1.023~24.140, P = 0.047). No difference was observed in adverse effects between the RT and OP groups (P = 0.154) and in ≥grade 3 adverse effects (P = 0.852). The study found that surgery was more frequently selected for elderly cervical cancer patients with adenocarcinoma and IB1 stage cancer in the real-world setting. After PSM to balance the biases, it showed that compared with radiotherapy, surgery could improve the OS of elderly early-stage cervical cancer patients and was an independent protective factor of OS in elderly early-stage cervical cancer patients.

Effect of flurbiprofen axetil on pain and cognitive dysfunction after radical operation of cervical cancer in elderly patients.

article: Effect of flurbiprofen axetil on pain and cognitive dysfunction after radical operation of cervical cancer in elderly patients - Minerva Surgery 2022 October;77(5):525-7 - Minerva Medica - Journals

Prognostic Nomogram for Overall Survival of Patients Aged 50 Years or Older with Cervical Cancer.

ObjectiveThe prognostic factors of cervical cancer in elderly patients have not been researched systematically. We aimed to investigate the clinicopathological characteristics of patients with cervical cancer aged ≥50 years and establish a nomogram for evaluating their prognoses for overall survival.MethodsFrom the Surveillance, Epidemiology, and End Results database, we obtained data of 8538 patients with pathology-confirmed cervical cancer between 2004 and 2015. Patients were divided into training (n = 5941) and validation (n = 2597) cohorts. A nomogram was constructed to evaluate the prognostic prediction value for disease progression. The concordance index, receiver operating characteristic curve, and calibration chart were used to evaluate the model’s prediction accuracy and discriminative ability. Survival condition was analyzed using the Kaplan–Meier method.ResultsIn the training cohort, age at diagnosis, race, histology, grade, stage, tumor size, number of examined lymph nodes, and treatment significantly correlated with outcome and were used to develop the nomogram. The calibration curve for survival probability showed an excellent agreement between the nomogram-predicted and actual survival in the training cohort.ConclusionOur nomogram has less bias and gives better accuracy than the International Federation of Gynecology and Obstetrics staging system and can help set up a more individualized feasible follow-up plan.

&lt;p&gt;Selective Use of Concurrent Chemotherapy in Elderly Cervical Cancer Patients Treated with Definitive Radiotherapy: Experience from Two Institutions [Erratum]&lt;/p&gt;

[This corrects the article DOI: 10.2147/CMAR.S190025.].

Major adverse events and prognostic factors in elderly patients with cervical cancer undergoing intensive-modulated radiotherapy combined with intravaginal brachytherapy

Objective To investigate the adverse effects and clinical efficacy of the intensive modulated radiotherapy(IMRT)and intravaginal brachytherapy combined with versus without chemotherapy in elderly patients with cervical cancer, and to analyze its prognostic factors. Methods Clinical data and follow-up results of 214 patients with cervical cancer aged ≥60 years undergoing IMRT and intravaginal brachytherapy combined with or without chemotherapy were retrospectively analyzed.The overall survival(OS)rate was calculated by using the Kaplan-Meier method.Prognostic factors were analyzed by Log-rank single factor test and Cox multivariate analysis. Results The rates of myelosuppression(≥grade 3)was higher in the concurrent chemo-radiotherapy group than in simple radiotherapy group(48.6% vs.15.8%, χ2=27.372, P<0.05). The complete response(CR)rate was higher in the concurrent chemo-radiotherapy group than in the simple radiotherapy group(83.0% vs.68.3%, χ2=5.993, P=0.014). The 1-, 3- and 5-year OS rate were 92.2%, 79.3% and 65.6%, respectively in all patients.Univariate analysis showed that the staging, lymph node metastasis status, pathological type and short-term efficacy of cervical cancer(based on FIGO guideline)were influencing factors for the prognosis(χ2=4.321-30.316, all P<0.05). Multivariate analysis showed that the FIGO staging, lymph node metastasis status and short-term efficacy were independent influencing factors for the prognosis(χ2=5.284-14.261, all P<0.05). Conclusions The intensive modulated radiotherapy and intravaginal brachytherapy combined with chemotherapy have a good efficacy and favorable long-term survival rate for the treatment of cervical cancer in elderly patients, and its major adverse effects can be tolerated.The FIGO staging, lymph node metastasis status and short-term efficacy are independent influencing factors for the prognosis in elderly patients with cervical cancer. Key words: Uterine cervical neoplasms; Radiotherapy; Prognosis

Real-world treatment patterns, survival, and cost among elderly cervical cancer patients.

e18226 Background: Limited chemotherapy data is available for elderly cervical cancer patients (pts). This study aimed to investigate real-world use of systemic therapies, survival, and costs among elderly pts in U.S. Methods: Pts who aged 65+ years and initially diagnosed with cervical cancer between 2007 and 2013 were identified using the SEER-Medicare data. Regimens were classified into 3 mutually-exclusive categories, i.e. cisplatin (Cis), carboplatin (Car), and Other based therapies. Chemotherapy within 90 days of surgery or radiation therapy were not considered as first line (1L) systemic therapy. All costs were converted to 2016 US dollars. Results: A total of 1 651 eligible pts were identified with 430 (26%) being stage IV at diagnosis. Among pts received systemic therapies, the median overall survival (OS) was 14 m from 1L initiation and 10 m from 2L initiation. Among 225 pts who received 1L, 58% pts received Cis-based therapy, and 17% pts received Car-based therapy. Car + paclitaxel was the most commonly used regimen (44%). Among 73 pts who received 2L, 34% and 15% pts received Cis- and Car-based therapy, respectively. Pts with 2L therapy received a variety of regimens with the top 3 being Car + paclitaxel (19%), gemcitabine (11%), and topotecan (9.6%). Median duration of treatment (DOT) was 4-6 m across line of therapies (LOTs), yet median time to next treatment (TTNT) ranged 10-32 m for 1L, and 9-11 m for 2L. The average per person per month (PPPM) costs were 7.1k for 1L and 8.8k for 2L with primary drivers of spending being outpatient and emergency room visits. Conclusions: Elderly pts with advanced cervical cancer requiring chemotherapy had poor prognosis and had no standard of care for 2L therapy. Per-patient economic burden is substantial for both 1L and 2L therapy, exceeding 7k dollars per month. [Table: see text]

Selective use of concurrent chemotherapy in elderly cervical cancer patients treated with definitive radiotherapy: experience from two institutions.

Background: Whether concurrent chemotherapy could bring about better oncological outcomes in elderly patients receiving definitive radiotherapy is still unknown. So, the purpose of this study was to find out whether it is essential for elderly patients to undergo concurrent chemotherapy.Methods: We performed a retrospective study of 246 elderly cervical cancer patients who were treated with definitive radiotherapy or chemo-radiation between August 2004 and August 2015. All patients were divided into two groups according to whether they were receiving concurrent chemotherapy or not. Overall survival (OS) and disease-free survival (DFS) were compared between the two groups. Recurrence patterns were also analyzed. Multivariate analysis was performed to explore clinical factors significantly associated with DFS, local recurrence-free survival, and distant metastasis-free survival (DMFS).Results: The 5-year OS in the radiotherapy and chemo-radiation groups were 72.89% and 82.25%, respectively. A significant difference was found between the two groups (P=0.016). The 5-year DFS in the radiotherapy and chemo-radiaton groups were 58.19% and 75.52%, respectively, also with a significant difference between the two groups (P=0.028). Further subgroup analysis showed that in patients with negative lymph nodes, there were no differences in both OS and DFS between patients who did and did not receive concurrent chemotherapy. However, in patients with positive lymph nodes, patients who received concurrent chemotherapy acquired better OS and DFS than those who did not. Multivariable analysis showed that concurrent chemotherapy was an independent predictor of DFS and DMFS.Conclusion: Concurrent chemotherapy could improve oncological outcomes in elderly cervical cancer patients with positive lymph nodes, but not in those with negative lymph nodes.

Clinical and prognostic analysis of elderly patients with cervical cancer

Objective To explore the prognosis and risk factors for cervical cancer in elderly patients. Methods Clinical data of 337 elderly patients(≥ 65 years old)admitted into Zhejiang Cancer Hospital from June 2008 to June 2013 were retrospectively analyzed.Clinical data and the follow-up information were collected.The correlation of prognosis with age, performance status score, International Federation of Gynecology and Obstetrics(FIGO)staging, tumor size, pathological type, treatment and comorbidities were analyzed. Results Among 337 elderly patients, the 5-year overall survival(OS)rates for patients with stage Ⅰ, Ⅱ, Ⅲ, Ⅳ were 81.8%, 62.3%, 53.5%and 0.0%, respectively(χ2=63.414, P=0.000); local recurrence rate was 33.5%; the 5-year OS rate of patients with and without comorbidities were 54.0% and 70.0%, respectively(χ2=8.907, P=0.003). Among 119 cervical cancer patients with stage ⅠA-ⅡA, 5-year OS for surgery group and radiotherapy group were 83.5% and 55.0%, respectively(χ2=13.161, P=0.000). Among 218 advanced cervical cancer patients, the 5 year OS for chemoradiotherapy and radiotherapy groups were 69.7% and 51.9%, respectively(χ2=4.030, P=0.045). The acute toxicity reactions of radiotherapy and chemoradiotherapy groups were as follows.The incidences of acute grades 3-4 hematological toxicity were 9.7% and 42.4% in radiotherapy group and chemoradiotherapy groups respectively(χ2=21.362, P=0.000), and the incidences of acute grade 3 gastrointestinal toxicity were 5.9% and 9.1%(χ2=0.086, P=0.769)in radiotherapy group and chemoradiotherapy group, respectively.No grade 4 gastrointestinal toxicity was found.Multivariate Cox regression analysis showed that age, PS score, FIGO staging, pathological type, treatment and comorbidities were influencing factors for prognosis in elderly patients with cervical cancer(P<0.05). Conclusions Elderly cervical cancer patients have a good tolerance to treatment.The comorbidity is one of negatively influencing factors for prognosis.The efficacy of definitive radiotherapy is inferior to surgery in elderly patients with early stage cervical cancer due to the high proportion of comorbidities.Concurrent chemoradiotherapy can improve the prognosis of middle and advanced cervical cancer in elderly patients. Key words: Uterine cervical neoplasms; Prognosis

Postoperative chemoradiotherapy versus radiotherapy alone for elderly cervical cancer patients with positive margins, lymph nodes, or parametrial invasion.

ObjectiveWomen with cervical cancer (CC) found to have positive surgical margins, positive lymph nodes, and/or parametrial invasion receive a survival benefit from postoperative chemoradiotherapy (CRT) vs. radiation therapy (RT) alone. However, older women may not benefit to the same extent, as they are at increased risk of death from non-oncologic causes as well as toxicities from oncologic treatments. This study sought to evaluate whether there was a survival benefit of CRT over RT in elderly patients with cervical cancer.MethodsThe National Cancer Database was queried for patients ≥70 years old with newly diagnosed IA2, IB, or IIA CC and positive margins, parametrial invasion, and/or positive nodes on surgical resection. Statistics included logistic regression, Kaplan-Meier overall survival (OS), and Cox proportional hazards modeling analyses.ResultsAltogether, 166 patients met inclusion criteria; 62 (37%) underwent postoperative RT and 104 (63%) underwent postoperative CRT. Younger patients and those living in areas of higher income were less likely to receive CRT, while parametrial invasion and nodal involvement were associated with an increased likelihood (p<0.05 for all). There were no OS differences by treatment type. Subgroup analysis by number of risk factors, as well as each of the 3 risk factors separately, also did not reveal any OS differences between cohorts.ConclusionIn the largest such study to date, older women with postoperative risk factor(s) receiving RT alone experienced similar survival as those undergoing CRT. Although causation is not implied, careful patient selection is paramount to balance treatment-related toxicity risks with theoretical outcome benefits.

Outcome and toxicity of radical radiotherapy or concurrent Chemoradiotherapy for elderly cervical cancer women

BackgroundConcurrent chemoradiotherapy (CCRT) is the standard treatment for local advanced cervical cancer. However, for elderly patients, studies are limited and the outcomes are controversial. We retrospectively analyzed the efficacy and tolerance of radical radiotherapy (RT) or CCRT in elderly cervical cancer patients and performed comparisons between them.MethodsWe retrospectively analyzed the elderly cervical cancer patients (≥70 years old) treated with radical RT or CCRT between January 2006 and December 2014. For external beam radiotherapy, 50Gy in 25 fractions or 50.4Gy in 28 fractions were delivered via 3-dimensional conformal radiation therapy or intensity modulated radiation therapy. High-dose-rate intracavitary brachytherapy was performed with a dose of 30-36Gy in 5–7 fractions to point A. Concurrent chemotherapy regimens included weekly cisplatin and paclitaxel.ResultsSeventy-three patients were eligible for this study. Twenty-one(28.8%) and 52(71.2%) patients suffered with FIGO stage IB-IIA and IIB-IVA disease, respectively. Twenty-four (32.9%) patients received CCRT. The median duration of follow-up was 32.4 months (4.8–118.8 months). The 3-year overall survival (OS), cancer-specific survival (CSS) and disease-free survival (DFS) were 64.9%, 67.8% and 66.5%, respectively. By multivariate analysis, CCRT was a significant predictive factor of OS(p = 0.023, 95% confidence interval [CI]: 1.172–8.860), CSS(p = 0.031, 95% CI: 1.131–13.908)and DFS(p = 0.045, 95% CI: 1.023 ~ 6.430). The 3-year OS of patients received RT and CCRT were 54.3% and 83.1%, CSS were 56.8% and 87.1%, DFS were 57.6% and 83.3%. There was no treatment related death. Grade 3–4 acute hematological, gastrointestinal and urinary toxicity incidences were 31.5%, 19.1% and 12.3%, respectively. For grade 3–4 chronic gastrointestinal and genitourinary toxicities, the incidences were 4.1% and 2.7%, respectively. Compared with RT, CCRT was related with high grade 3–4 hematological toxicity (16.3% and 62.5% respectively, p < 0.001), respectively. However, acute nonhematological toxicity and chronic toxicity were not significantly different.ConclusionElderly cervical cancer patients could tolerate radical RT and CCRT very well and get a favored survival. Compared with RT, CCRT could improve the survival of elder cervical cancer patients with similar nonhematological toxicity. CCRT should be considered in elderly cervical cancer patients.

Towards a privacy preserving cohort discovery framework for clinical research networks

The last few years have witnessed an increasing number of clinical research networks (CRNs) focused on building large collections of data from electronic health records (EHRs), claims, and patient-reported outcomes (PROs). Many of these CRNs provide a service for the discovery of research cohorts with various health conditions, which is especially useful for rare diseases. Supporting patient privacy can enhance the scalability and efficiency of such processes; however, current practice mainly relies on policy, such as guidelines defined in the Health Insurance Portability and Accountability Act (HIPAA), which are insufficient for CRNs (e.g., HIPAA does not require encryption of data - which can mitigate insider threats). By combining policy with privacy enhancing technologies we can enhance the trustworthiness of CRNs. The goal of this research is to determine if searchable encryption can instill privacy in CRNs without sacrificing their usability. We developed a technique, implemented in working software to enable privacy-preserving cohort discovery (PPCD) services in large distributed CRNs based on elliptic curve cryptography (ECC). This technique also incorporates a block indexing strategy to improve the performance (in terms of computational running time) of PPCD. We evaluated the PPCD service with three real cohort definitions: (1) elderly cervical cancer patients who underwent radical hysterectomy, (2) oropharyngeal and tongue cancer patients who underwent robotic transoral surgery, and (3) female breast cancer patients who underwent mastectomy) with varied query complexity. These definitions were tested in an encrypted database of 7.1 million records derived from the publically available Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS). We assessed the performance of the PPCD service in terms of (1) accuracy in cohort discovery, (2) computational running time, and (3) privacy afforded to the underlying records during PPCD. The empirical results indicate that the proposed PPCD can execute cohort discovery queries in a reasonable amount of time, with query runtime in the range of 165-262s for the 3 use cases, with zero compromise in accuracy. We further show that the search performance is practical because it supports a highly parallelized design for secure evaluation over encrypted records. Additionally, our security analysis shows that the proposed construction is resilient to standard adversaries. PPCD services can be designed for clinical research networks. The security construction presented in this work specifically achieves high privacy guarantees by preventing both threats originating from within and beyond the network.

Weekly Cisplatin and Volumetric Modulated Arc Therapy With Simultaneous Integrated Boost for Radical Treatment of Advanced Cervical Cancer in Elderly Patients: Feasibility and Clinical Preliminary Results

Weekly Cisplatin and Volumetric Modulated Arc Therapy With Simultaneous Integrated Boost for Radical Treatment of Advanced Cervical Cancer in Elderly Patients: Feasibility and Clinical Preliminary Results

Weekly Cisplatin and Volumetric-Modulated Arc Therapy With Simultaneous Integrated Boost for Radical Treatment of Advanced Cervical Cancer in Elderly Patients: Feasibility and Clinical Preliminary Results.

To evaluate the feasibility and clinical preliminary results of weekly cisplatin and volumetric-modulated arc therapy to the pelvis with simultaneous integrated boost to macroscopic disease in a cohort of elderly patients. Inclusion criteria of this prospective study were age ≥70 years, Karnofsky performance status 70 to 100, locally advanced histologically proven squamous cervical carcinoma, and patients unable to undergo brachytherapy. Radiation doses prescribed were 66 Gy to the macroscopic disease and 54 Gy to the pelvic nodes in 30 fractions. Weekly cisplatin dose was 40 mg/mq. A total of 30 patients were recruited. Median follow-up was 32 months (range: 8-48 months). Median age was 72 years (range: 70-84 years). The 3-year overall survival and local control were 93% and 80%, respectively. The median time to progression was 24 months (range: 6-30 months). Analyzing clinical outcome grouping based on the stage of disease, II versus III, the 3-year overall survival was 100% and 85%, respectively. The 3-year local control was 91% for stage II and 67% for stage III. Acute and late toxicities were acceptable without severe events. Weekly cisplatin and volumetric-modulated arc therapy-simultaneous integrated boost for radical treatment of advanced cervical cancer in the current cohort of elderly patients were feasible. Long-term results and prospective randomized trials are advocated.

1307 Treatment outcomes of definitive or postoperative radiotherapy in elderly cervical cancer patients

1307 Treatment outcomes of definitive or postoperative radiotherapy in elderly cervical cancer patients

Patterns of Care and Outcome in Elderly Patients With Cervical Cancer: A Retrospective Analysis

The goal of this report was to evaluate the efficacy and tolerance of chemoradiotherapy in elderly cervical cancer patients. One hundred thirteen patients aged older than 75 years had been treated in Mackay Memorial Hospital with Zubrod performance status 0–1. Patients were classified into three groups: Group 1 with radiation less then 45 Gy for palliation or no radiotherapy, Group 2 with at least 45 Gy to whole pelvis with or without brachytherapy, and Group 3 with completed radiotherapy with brachytherapy of 30 Gy and concurrent chemotherapy. Toxicities were graded weekly according to National Cancer Institute Common Toxicity Criteria version 3.0. Overall survival and progression-free survival were analyzed with Kaplan-Meier method and compared by the log-rank test. About 30% of the patients had diabetes or hypertension or both. Only one case with adenocarcinoma was noted in Group 2. Higher ratio of Stage IV disease was noted in Group 1, but clinical stage is not significantly different in the three groups ( p = 0.55). In Group 3, 52% patients completed six cycles of cisplatin-based chemotherapy, but higher noncancer-related death ratio was noted. The 5-year actuarial overall survival of Group 1, Group 2, and Group 3 is 11%, 27%, and 74%, respectively ( p < 0.001). The 5-year progression-free survival of Group 1, Group 2, and Group 3 is 11%, 24%, 64%, respectively ( p = 0.003). Chemoradiotherapy is effective and tolerable in elders with cervical cancers. Chemoradiotherapy should be considered in elderly patients with invasive cervical cancer.

Patterns of Care and Outcome in Elderly Patients with Cervical Cancer: A Retrospective Analysis

Purpose/Objective(s)The goal of this report was to evaluate the efficacy and tolerance of chemoradiotherapy in elderly cervical cancer patients.Materials/MethodsOne hundred thirteen patients aged over 75 had been treated in Mackay Memorial Hospital with Zubrod performance status 0-1. Patients were classified into three groups: group 1 with radiation less then 45Gy for palliation or no radiotherapy, group 2 with at least 45Gy to whole pelvis with or without brachytherapy and group 3 with completed radiotherapy with brachytherapy 30Gy and concurrent chemotherapy. Toxicities were graded weekly according National Cancer Institute Common Toxicity Criteria version 3.0. Overall survival (OS) and progression -free survival (PFS) were analyzed with Kaplan and Meier method and compared by the log-rank test.ResultsAbout 30% patients had diabetes or hypertension or both. Only one case with adenocarcinoma was noted in group 2. Higher ratio of stage IV disease was noted in group1, but clinical stage is not significantly different in there three groups (p=0.55). In group 3, 52% patients completed 6 cycles of cisplatin-based chemotherapy, but higher non-cancer related death ratio was noted. The 5-year actuarial overall survival of group1, group2 and group3 is 11%, 27% and 74% (p<0.001). The 5-year progression free survival of group1, group2 and group3 is 11%, 24% 64% (p = 0.003).ConclusionsChemoradiotherapy is effective and tolerable in elder cervical cancers. Chemoradiotherapy should be considered in elderly patients with invasive cervical cancer. Purpose/Objective(s)The goal of this report was to evaluate the efficacy and tolerance of chemoradiotherapy in elderly cervical cancer patients. The goal of this report was to evaluate the efficacy and tolerance of chemoradiotherapy in elderly cervical cancer patients. Materials/MethodsOne hundred thirteen patients aged over 75 had been treated in Mackay Memorial Hospital with Zubrod performance status 0-1. Patients were classified into three groups: group 1 with radiation less then 45Gy for palliation or no radiotherapy, group 2 with at least 45Gy to whole pelvis with or without brachytherapy and group 3 with completed radiotherapy with brachytherapy 30Gy and concurrent chemotherapy. Toxicities were graded weekly according National Cancer Institute Common Toxicity Criteria version 3.0. Overall survival (OS) and progression -free survival (PFS) were analyzed with Kaplan and Meier method and compared by the log-rank test. One hundred thirteen patients aged over 75 had been treated in Mackay Memorial Hospital with Zubrod performance status 0-1. Patients were classified into three groups: group 1 with radiation less then 45Gy for palliation or no radiotherapy, group 2 with at least 45Gy to whole pelvis with or without brachytherapy and group 3 with completed radiotherapy with brachytherapy 30Gy and concurrent chemotherapy. Toxicities were graded weekly according National Cancer Institute Common Toxicity Criteria version 3.0. Overall survival (OS) and progression -free survival (PFS) were analyzed with Kaplan and Meier method and compared by the log-rank test. ResultsAbout 30% patients had diabetes or hypertension or both. Only one case with adenocarcinoma was noted in group 2. Higher ratio of stage IV disease was noted in group1, but clinical stage is not significantly different in there three groups (p=0.55). In group 3, 52% patients completed 6 cycles of cisplatin-based chemotherapy, but higher non-cancer related death ratio was noted. The 5-year actuarial overall survival of group1, group2 and group3 is 11%, 27% and 74% (p<0.001). The 5-year progression free survival of group1, group2 and group3 is 11%, 24% 64% (p = 0.003). About 30% patients had diabetes or hypertension or both. Only one case with adenocarcinoma was noted in group 2. Higher ratio of stage IV disease was noted in group1, but clinical stage is not significantly different in there three groups (p=0.55). In group 3, 52% patients completed 6 cycles of cisplatin-based chemotherapy, but higher non-cancer related death ratio was noted. The 5-year actuarial overall survival of group1, group2 and group3 is 11%, 27% and 74% (p<0.001). The 5-year progression free survival of group1, group2 and group3 is 11%, 24% 64% (p = 0.003). ConclusionsChemoradiotherapy is effective and tolerable in elder cervical cancers. Chemoradiotherapy should be considered in elderly patients with invasive cervical cancer. Chemoradiotherapy is effective and tolerable in elder cervical cancers. Chemoradiotherapy should be considered in elderly patients with invasive cervical cancer.

Clinical analysis of 215 elderly patients with cervical cancer

To investigate the clinical features, treatment outcomes and possible prognostic factors in elderly patients with cervical cancer. Clinical data of 215 elderly women (> or = 65-years-old) with cervical cancer were retrospectively analyzed. Most patients (89.3%) had advanced stage ( II b-IV) disease. Eight of the 215 patients (3.7%) underwent surgical treatment, and six of those received postoperative radiotherapy. 133 patients received radiotherapy alone, and 74 patients underwent concurrent chemotherapy and radiotherapy. The median follow-up time was 48 months (range: 12-102 months). The overall 5-year survival rate was 63.7%. The 5-year survival rate for stage I, II, III, IV were 83.2%, 76.4%, 39.0% and 0, respectively. There was no significant difference in 5-year survival rate between patients treated with concurrent chemotherapy combined with radiotherapy and radiotherapy alone. In multivariate analysis, lymph node metastasis, advanced stage, non-squamous histologies and poor differentiation were all negative prognostic factors for the overall survival. The treatment strategy for elderly cervical cancer patients should be individually planned according to the disease stage and performance status of the patients. Usually, one radical therapy modality can be chosen, and combined modality therapy is not suggested.

Patterns of care and outcome in elderly cervical cancer patients: A special focus on brachytherapy

The mean age of the general population has been prolonged and the incidence of cancer in elderly patients has increased. The purpose was to evaluate outcome of brachytherapy (BT) as an integrated part of the treatment of elderly patients with cervical cancer. From November 1997 to January 2006, 1073 patients diagnosed with uterine cervical cancer with stages I-IV (FIGO) have completed BT at the Institut Gustave Roussy. A retrospective analysis was carried out with 113 patients aged over 70-year-old treated by conventional low dose rate (LDR) BT as a part of their treatment. The median age was 76 years (range, 70.7-94.4). Eighty-four percent of the patients presented a squamous cell carcinoma. Fifty-two percent of the patients were treated by a sequence excluding surgery. The mean 15 and 60 Gy treated volumes were 235 cm(3) (range, 30-371) and 138 cm(3) (range, 81-234), respectively. For the 15 Gy treated volume, the mean ICRU bladder and rectal points were 18.5 Gy (range, 6-35) and 33 Gy (range, 5-63), respectively. For the 60 Gy treated volume, the mean ICRU bladder and rectal points were 33 Gy (range, 12-64) and 41 Gy (range, 23-65), respectively. Rectal, small bowel and urinary tract complications were observed in 25 (22.1%), 5 (4.4%), and in 16 patients (14.2%), respectively. Rectal complications Grades I/II, III/IV and V (fatal) crude incidences were 19.4% (22/113), 1.8% (2/113) and 0.9% (1/113), respectively. Acute toxicity death occurred in one patient with major diarrhea associated with a hemodynamic shock. Small bowel complications Grades I/II and III/IV crude incidences were 3.5% (4/113) and 0.9% (1/113), respectively. Urinary tract complications Grades I/II and III/IV crude incidences were 11.5% (13/113) and 2.7% (3/113), respectively. With a median follow-up of 3.1 years, 10 patients developed distant metastases and 10 others presented local relapses. The 3-year specific overall survival rate was 88.6% (95%CI, 77-92) and the corresponding disease-free survival rate was 81% (95%CI, 72-88). Elderly women with cervical cancer tolerated BT well and had excellent local disease-free and specific survival rates. Age did not influence the effectiveness of BT in elderly patients and BT should be considered whenever possible, even in elderly patients presenting with a cervix cancer.

Chemoradiation for invasive cervical cancer in elderly patients: outcomes and morbidity

Age may impact survival and treatment in cervical cancer patients. We sought to determine if treatment and survival were different in elderly patients and whether chemoradiation increased morbidity. We performed a retrospective chart review to identify patients treated with definitive radiation therapy at the University of Iowa Hospitals and Clinics between 1997 and 2001. Three hundred sixty-four patients had a new diagnosis of invasive cervical cancer, of which 150 patients were treated with radiation. We excluded patients treated postoperatively or with palliative intent, leaving 96 patients treated with definitive radiation therapy. Patients were divided into two age categories: elderly (≥65) and nonelderly (&lt;65). We compared these groups with respect to treatment received, morbidity, and survival. Sixty-nine (72%) women were less than 65 years old, and 27 (28%) women were greater than or equal to 65 years old. Chemoradiation was associated with decreased mortality (P&lt; 0.01). The decrease in mortality did not differ between the two age cohorts (all causes:P= 0.66; cancer specific:P= 0.65), nor was there a difference in the complication rate due to chemoradiation (P= 0.70). Although elderly patients were more likely to be diagnosed with nonsquamous histologies (P&lt; 0.01), their odds of receiving chemoradiation were 0.35 (95% CI: 0.13–0.90) times the odds for nonelderly. Elderly cervical cancer patients more often have nonsquamous histology and are likely to receive only radiation therapy compared to younger patients. Treatment with chemoradiation was associated with similar survival increases in both age cohorts. Complication rates between the two were similar. Chemoradiation should be considered in elderly patients with invasive cervical cancer.