To the Editor: Life expectancy has progressively increased over past decades concomitantly with advances in medicine and with improvements in standards of living in developed countries. It is estimated that there could be 200,000 centenarians in France by the middle of the 21st century.1 Although it has been said that cancer in centenarians frequently has modest life-threatening potential, cancer can be a significant cause of morbidity.2 There are few studies on anticancer therapies in these individuals, and the feasibility of radiotherapy (RT) has never been reported. A multicenter experience with RT in the management of skin cancer in centenarians is briefly described. Between June 2009 and August 2012, 10 centenarians receiving RT for a histologically confirmed carcinoma were identified, accounting for 0.05% of approximately 12,000 individuals treated in four institutions (two university hospitals, two private centers). One received pelvic RT for a bladder carcinoma, and another received RT for bone metastases from prostate cancer. The eight remaining individuals, who received nine RT courses for a cutaneous carcinoma, were studied. Median age was 101.0 (range 99.8–106.7). Most of the individuals presented with poor general health status and were living in institutions. All tumors were in the head and neck area. Treatment was delivered with palliative intent in half of the subjects. All RT courses were delivered using a high-voltage linear accelerator. Median total dose was 30 Gy (range 20–49 Gy). All but one individual received hypofractionated RT (HFRT). The median number of fractions was 6 (range 4–13 fractions). Total treatment duration was 17 days (range 3–29 days). Median dose per fraction was 5.75 Gy (range 2.25–8 Gy). For each individual, the total biologically equivalent dose in 2 Gy fractions (EQD2) was calculated using the linear quadratic model and an alpha/beta of 10 Gy for tumors. Total EQD2 was 37.5 Gyα/β = 10 (range 25–64 Gyα/β = 10). Acute toxicities were scored according to the National Cancer Institute Common Toxicity Criteria, version 3, which displays Grade 1 (mild adverse effect) to 5 (death related to adverse effect).3 Most toxicities were mild to moderate, with high-grade toxicity requiring treatment disruption reported in only one subject, all toxicities being epithelitis. Three subjects received no follow-up from their radiation oncologist, and median follow-up was 8 weeks in the remaining subjects. Two subjects had more than 6 months of follow-up without delayed toxicity. All subjects were living at last follow-up, and only one experienced tumor progression (Table 1). Although some data suggest that RT is feasible in nonagenarians, this is the first report focusing on RT in centenarians.4-6 It showed that cutaneous tumors are the most frequently irradiated tumors, which is not the case in younger individuals. Analysis of the literature suggests that these long-living individuals could be protected from other cancer-related disorders through genetic specificities (low insulin-like growth factor-1–mediated response, high level of anti-inflammatory cytokines).7 Moreover, this study reflects clinical practice in unselected individuals. Most participants were managed at a late stage of their disease, with tumor-related symptoms. Because of the extreme vulnerability of centenarians, physicians are usually reluctant to perform invasive surgery requiring further reconstruction. Three subjects were treated with RT as single treatment modality; the remaining subjects underwent surgery and then were treated with RT, as adjuvant or for recurrent disease. Because of insufficient follow-up, local efficacy could not be thoroughly examined. These subjects frequently presented with poor general health status and ambulatory difficulties, and most of them followed up with their dermatologist. The study showed that RT was feasible, with low acute toxicity. HFRT is frequently proposed as an alternative to standard fractionation in elderly adults.8-10 Although hypofractionation can increase long-term toxicity, this is not a significant concern in this population. RT parameters (e.g., total dose, dose per fraction, target volumes) should be chosen carefully because they are associated with acute toxicity. Concurrent radiosensitizers agents are also not recommended because they may increase toxicity. Total equivalent dose was approximately 33% lower than usually recommended in these tumors according the evidence-based guidelines from the National Comprehensive Cancer Network. This study showed that a nonstandard RT scheme is frequently proposed, with lower total doses and frequent use of fractionation, based on the subjective analysis of the physician. Although elderly adults have low physiological reserves and geriatric vulnerabilities, there is no evidence of a relationship between age and local toxicity. Prospective data are required to refine the optimal treatment modality in elderly adults through an integrative oncogeriatric approach. Conflict of Interest: The authors report no conflict of interest relative to this work. Author Contributions: Chargari, Moriceau, Auberdiac, Guy, Assouline, Eddekkaoui, Annede, Trone, Jacob, Pacaut, Bauduceau, Vedrine, Magne: acquisition, analysis, and interpretation of data. Chargari, Magne: preparation of manuscript. Sponsor's Role: No sponsorship.