Strategy In Elderly Patients Research Articles

Pilot study of gamma-knife surgery-incorporated systemic chemotherapy omitting whole brain radiotherapy for the treatment of elderly primary central nervous system lymphoma patients with poor prognostic scores

Systemic chemotherapy followed by whole brain radiotherapy (WBRT) is a widely used treatment strategy for patients with primary central nervous system lymphoma (PCNSL). However, the outcome of this treatment strategy in elderly patients, particularly with a poor prognostic score, was disappointing compared with younger patients, and the deterioration of cognitive function after WBRT is more problematic in these patients. To avoid this debilitating complication of WBRT and increase treatment efficacy in elderly patients, we designed systemic chemotherapy that incorporated interim gamma-knife surgery (GKS) treatment for elderly PCNSL patients (age≥65 years), omitting WBRT in this pilot trial. A total of four elderly patients with a poor prognostic score based on an International Extranodal Lymphoma Study Group were enrolled in this pilot clinical trial. All study patients acquired complete response and showed stable or improved neuropsychological function during the disease-free state. The median progression-free survival was 9.5 months (range 8.6-22.5 months), and the median overall survival was 15.8 months (range 13.3-25.1 months), which were likely to be similar to those of the chemotherapy followed by WBRT for those patients. This pilot study demonstrated that GKS-incorporated systemic chemotherapy can obtain complete response with high probability and considerably long survival, which suggests that this treatment strategy is efficient and neuropsychologically safe for elderly PCNSL patients with a poor prognostic score.

Revascularization improves mortality in elderly patients with acute myocardial infarction complicated by cardiogenic shock

Cardiogenic shock (AMI-CS) occurs in 2.5–6% of hospitalized patients with acute myocardial infarction (AMI), and is associated with high morbidity and mortality [ 1 Hochman J.S. Cardiogenic shock complicating acute myocardial infarction: expanding the paradigm. Circulation. 2003; 107: 2998-3002 Crossref PubMed Scopus (451) Google Scholar , 2 Holmes Jr., D.R. Berger P.B. Hochman J.S. et al. Cardiogenic shock in patients with acute ischemic syndromes with and without ST-segment elevation. Circulation. 1999; 100: 2067-2073 Crossref PubMed Scopus (187) Google Scholar , 3 Goldberg R.J. Spencer F.A. Gore J.M. Lessard D. Yarzebski J. Thirty-year trends (1975 to 2005) in the magnitude of, management of, and hospital death rates associated with cardiogenic shock in patients with acute myocardial infarction: a population-based perspective. Circulation. 2009; 119: 1211-1219 Crossref PubMed Scopus (485) Google Scholar , 4 Goldberg R.J. Gore J.M. Thompson C.A. Gurwitz J.H. Recent magnitude of and temporal trends (1994–1997) in the incidence and hospital death rates of cardiogenic shock complicating acute myocardial infarction: the second national registry of myocardial infarction. Am Heart J. 2001; 141: 65-72 Abstract Full Text Full Text PDF PubMed Scopus (85) Google Scholar ]. In the aftermath of the SHOCK trial [ [5] Hochman J.S. Sleeper L.A. Webb J.G. et al. Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock. N Engl J Med. 1999; 341: 625-634 Crossref PubMed Scopus (2176) Google Scholar ], small observational studies reported on outcomes of elderly (≥75-year old) patients with AMI-CS (Supplement). Uncertainty however still exists regarding the benefits of early revascularization (ER) in elderly patients with AMI-CS. In the current report, we undertook aggregate data meta-analyses of short- and intermediate-term mortality outcomes to examine the impact of an ER strategy versus an initial medical stabilization (IMS) strategy in elderly patients with AMI-CS.

Age alone should not preclude surgery: Contemporary outcomes after aortic valve replacement in nonagenarians

Advanced age plays a major role in surgical risk algorithms; however, the outcomes data for the very elderly are lacking. We, therefore, evaluated the outcomes after surgical aortic valve replacement (SAVR) in nonagenarians (age, >90 years) at our institution during an 11-year period. The demographics, procedural details, and in-hospital outcomes were retrospectively analyzed for 119 nonagenarians with symptomatic, severe aortic stenosis who had undergone SAVR or SAVR plus concomitant surgery from 2001 to 2012. The mean follow-up period was 915±832 days. The average age was 91.7±1.9 years (range, 90-98), and the mean Society of Thoracic Surgeons score was 8.9±5.7. The mean aortic valve gradient was 45±16 mm Hg, mean aortic valve area was 0.66±0.2 cm2, and mean ejection fraction was 49.8%±11.8%; 47% underwent isolated SAVR. The average length of stay was longer than expected; however, the rates of prolonged ventilation (16.8%), new atrial fibrillation (43.7%), stroke (0.8%), and renal failure (5.9%) were acceptable. Three patients (2.5%) required reoperation for bleeding. Overall, the 30-day and 1-year mortality was 7.6% and 21.0%, respectively. The multivariate predictors of mortality at 1 year included previous myocardial infarction (hazard ratio, 2.79; 95% confidence interval, 1.21-6.45; P=.016), obstructive lung disease (hazard ratio, 3.90; 95% confidence interval, 1.66-9.15; P=.025), and diabetes (hazard ratio, 2.77; 95% confidence interval, 1.08-7.07; P=.033). The observed in-hospital mortality was lower than expected (observed/expected, 0.85). Excellent procedural and long-term outcomes can be achieved in nonagenarians, and age alone should not be a contraindication to SAVR in selected populations. Our sample cohort has validated the feasibility of a primary operative strategy in elderly patients with aortic stenosis and acceptable risk profiles.

Postoperative Complications and Survival after Gastric Cancer Surgery in Patients Older than 80 Years of Age

BackgroundThis study sought to identify and evaluate the risk factors of postoperative complications, prognostic factors, and appropriate surgical strategies in elderly patients undergoing surgery for gastric cancer. MethodsThe medical records of 396 radical gastrectomies conducted from January 2006 to December 2011 were retrospectively reviewed. Surgical results and survival rates were assessed for 60 elderly patients (aged ≥ 80 years) and 336 non-elderly patients (aged < 80 years). The study groups were compared with respect to clinicopathological findings, surgical outcomes, and survival. ResultsElderly patients underwent gastrectomies with shorter operation time, showed less extensive lymphadenectomy, and had a significant difference in overall survival compared with non-elderly patients, although there was no difference in cause-specific survival among patients receiving curative resection. No significant risk factors affecting postoperative complications were identified in the elderly patients. Number of comorbidities (≥2) (HR, 5.30; 95 % CI, 1.11–25.32; P = 0.037) and TNM stage (≥II) (HR, 12.97; 95 % CI, 1.60–105.38; P = 0.017) were identified as independent prognostic factors in the elderly patients receiving curative resection. ConclusionsAge is not an independent prognostic factor for patients receiving curative resection for gastric cancer. Multiple comorbidities may also influence the prognosis of elderly patients. Careful follow-up would improve overall survival for elderly patients.

Invasive treatment strategy in elderly patients with non ST elevation acute coronary syndromes. A sensitivity analysis of a large monocentric retrospective study

Background: Consistent benefit of invasive strategy (IS) in the management of myocardial infarction (MI) in elderly patients is not yet reported. Objectives: In non ST elevation acute coronary syndromes (NSTEACS) admitted within 48h of symptom onset, we aimed to determine in-hospital and 30-days mortality, and proportion of patients alive at 31 days to 6 months (T1) and 31 days to 12 months follow-up (T2). Cumulative rate of composite outcome (CO) of death/nonfatal MI/unstable angina was also analysed at 30 days, 6 and 12 months. Methods: A retrospective review of 453 consecutive patients > 75 yrs discharged after NSTEACS at a single ICCU between 2006 and 2010 was conducted. IS (n=301) or conservative strategy (CS) (n=152) were chosen as per medical judgment. Multivariate regression models to test the association between strategy and outcomes were used and a sensitivity analysis performed. Variables introduced into the models were age, gender, admission creatinine clearance, ejection fraction, haemoglobin and Killip classes, admission heart rate, blood pressure and cardiac arrest, ST deviation, peak troponin level, time from admission to percutaneous coronary intervenion (PCI), albumin serum levels. Results: Inhospital, 8 (2.7%) and 14 (9.2%), at 30 days, 11 (3,7%) and 21 (13,8%), at T1 28 (9,3%) and 44 (29,0%), and at T2 40 (13,3%) and 57 (37.5%), patients died in the IS and CS group respectively. At 30 days 25 (8,3%) and 24 (15,8%), at T1 52 (17,3%) and 56 (36,8%), and at T2 74 (24,6%) and 64 (42.1%), patients achieved the cumulative CO in the IS and CS group respectively. IS sizeably decreased adjusted in-hospital (OR 0.37, 95% CI 0.13-1.04, p=0.0603), 30-days (OR 0.28, 95% CI 0.12-0.67, p=0.004), T1 (T1 OR 0.33, 95% CI 0.16-0.67, p=0.0025) and T2 mortality (T2 OR 0.34, 95% CI 0.20-0.58, p=0.0001). IS correspondingly lowered cumulative rate of CO at 30 days (OR 0.55, 95% CI 0.28-1.07, p = 0.077), 6 months (OR 0.52, 95% CI 0.34-0.81, p = 0.003) and 12 months (OR 0.68, 95% CI 0.46-0.98, p = 0.0041). Further independent predictors of prognosis were also hemodynamic status (Killip class II-IV), or cardiac arrest at admission. Conclusions: IS was independently associated with a three-fold lower mortality and twofold lower CO in this high risk population at either brief, mid or long-term.

Catheter ablation for atrial fibrillation in the elderly

SUMMARY An important proportion of patients suffering from atrial fibrillation (AF) are in the patient age group over 65 years. Cardiac and noncardiac comorbidities are often present at this age and are challenging for pharmacological management. In the setting of hypertension, coronary artery disease, heart failure and left ventricular hypertrophy, specific antiarrhythmic drugs frequently fail due to adverse effects, proarrhythmic properties or impaired efficacy. Recently, catheter ablation became widely available as an effective therapy for symptomatic AF. However, a small number of elderly patients were enrolled in the large randomized trials, and international guidelines recommend a conservative strategy in elderly patients as the evidence-based data are limited. Nevertheless, our findings and the data of other groups show that ablation therapy is effective with acceptable risks for selected elderly patients even at octogenarian age, if AF is symptomatic despite pharmacological rate and rhythm control...

Treatment Strategy for Elderly Patients with Metastatic Colorectal Cancer: A Review of the Systemic Chemotherapy Options

Despite many recent advances in the treatment of metastatic colorectal cancer (mCRC) and corresponding improvements in patient survival, most of the pivotal trials have involved fit, young patients. Consequently, it is unclear whether efficacy and safety profiles from these large randomized trials are applicable to patients older than 70 years of age, who account for more than half of those with mCRC. Most of the conclusions regarding chemotherapy for elderly mCRC patients are derived from combined or subgroup analyses from large studies in which elderly patients are typically defined as those more than 65 or 70 years of age. In general, it was concluded that, as with young patients, systemic chemotherapy could be beneficial for these elderly patients also, with tolerable adverse events. Nonetheless, it was subsequently determined that serious adverse events occurred more frequently in elderly patients and that immediate intensive chemotherapy did not always result in better overall survival for this group. In patients scheduled for capecitabine, previous estimation of renal function and careful administration of the drug are necessary; however, contrary to expectations, the quality of life is not better than that achieved with 5-fluorouracil. Another therapeutic option is immediate doublet chemotherapy, but for elderly patients, a stop-and-go strategy or chemotherapy-free intervals should be considered. Targeted agents, including bevacizumab, cetuximab, and panitumumab, have resulted in outcomes no inferior for older than for younger patients, but they require further investigation to optimize their use. The variable findings obtained for elderly patients emphasize the need for a definition of “elderly” that takes into account not only chronological age, but also physiological age, socioeconomic status, and the results of objective tools such as comprehensive geriatric assessment.

Long‐Term Efficacy and Safety of Two Different Rhythm Control Strategies in Elderly Patients with Symptomatic Persistent Atrial Fibrillation

We prospectively compared the efficacy, safety, and quality of life (QoL) impact of catheter ablation versus antiarrhythmic drugs (AAD) in elderly patients with persistent atrial fibrillation (AF). Four hundred and twelve consecutive patients, aged ≥ 70 years, underwent ablation (Group A, 153 patients) or AAD (Group B, 259 patients). Study endpoints: treatment failure (any AF/AT lasting >30 seconds) and treatment-related adverse events (acute when ≤1 month of procedure and long term when >1 month). At a follow-up of 60 ± 17 months, 43% and 46% patients in Group B versus 58% and 76% in Group A were in sinus rhythm (SR), respectively, after one (P = 0.003) and 2 procedures (P < 0.001). Fifteen acute adverse events occurred (6.7% in Group A vs 1% in Group B, P < 0.001), mainly periprocedural cerebral thromboembolism (3.3% in Group A vs 0.7% in Group B, P = 0.058). Previous TIA/stroke resulted the only independent predictor of periprocedural cerebrovascular accidents (OR 1.2, 95%IC 1.1-1.3). At follow-up, 74 long-term adverse events occurred (7.7% in Group A vs 23.9% in Group B, P < 0.001) with Group B patients more often experiencing AAD-related adverse events (12.7% vs 2.6%, P < 0.001). Group A and absence of AF/AT recurrences significantly improved QoL scores (P < 0.001). In elderly persistent AF patients, catheter ablation is more effective in maintaining SR and in improving QoL than AAD but is affected by a higher risk of embolic complications, particularly in patients with previous TIA/stroke. Over time, Group A patients more likely discontinued AAD with a reduction of long-term adverse events.

2790 – Management of elderly patients consulting in psychiatry: critical thinking about the study of 159 cases

The prescription of psychotropic drugs in the elderly is more common. Doses are increasingly high, with frequent recourse to a combination therapy. Our purpose was to describe treatment strategies in elderly patients consulting in psychiatry, in order to confront them with the latest recommendations. Our study was retrospective and descriptive. It involved all elderly patients aged more than 60 years, who had consulted for the first time in psychiatry since January 2010 until December 2011. We collected, for each patient, the sociodemographic data, the diagnosis(es), the treatment(s), the side effects and the illness evolution under treatment. We collected 159 cases of elderly patients, representing 6.07% of all the consultants in psychiatry during the period of the study. Their average age was 73 with a sex-ratio (M/F) of 1.13. Dementia and mood disorders were the most common diagnoses (respectively 40.2% and 34.6%). As far as drug therapies are concerned, an antidepressant was prescribed to 95 patients (59.7%); an antipsychotic was prescribed to 55.3%. A tranquillizer was prescribed to 40.8%. A combination therapy made of at least two different families of psychotropic drugs was prescribed to 55.9% of the patients. None of the patients benefited from psychotherapy. Our study showed that the treatment strategy of the elderly consulting in psychiatry in the area of the study was not in accordance with the latest recommendations.

Bevacizumab plus radiotherapy for elderly patients with glioblastoma (ARTE).

TPS2105 Background: The standard of care for patients with newly diagnosed glioblastomas after surgical resection is radiotherapy with concomitant and adjuvant temozolomide chemotherapy. Yet, inclusion into the pivotal trial was limited to patients up to the age of 70, and subgroup analyses suggested that older patients did not gain benefit from combined modality treatment. Further, the efficacy of radiotherapy has been confirmed in a randomized trial comparing best supportive care versus radiotherapy alone. Of note, hypofractionated radiotherapy is equieffective in patients aged 65-70 years and more. Two randomized trials in elderly patients (NOA-08, Nordic Trial) indicated smilar efficacy of primary temozolomide chemotherapy alone compared with radiotherapy alone. Combined radiochemotherapy is compared with radiotherapy alone in an ongoing NCIC-CTG EORTC TROG Japanese group trial 26062-22061. Thus, radiotherapy alone is the standard of care for newly diagnosed glioblastoma of elderly patients. These clinical data justify the exploration of new, temozolomide-free first-line treatment strategies in elderly patients. Methods: The ARTE trial will therefore investigate bevacizumab when added to a short course of radiotherapy and bevacizumab maintenance therapy until progression. The translational research program shall include blood and urine biomarker analysis and FET-PET in addition to MRI for monitoring the course of the disease. This trial is an explorative randomized, non-comparative phase II trial aiming at recruiting 60 patients in Switzerland. Elderly patients (&gt; 65) will be randomized 2:1 either to the experimental arm (bevacizumab plus radiotherapy) or the standard arm (radiotherapy). The primary endpoint is median overall survival. Secondary endpoints include overall survival at 6 months, overall survival at 12 months, median progression-free survival, progression-free survival at 6 months, median time to treatment failure.

Feasibility and safety of transradial approach and bivalirudin treatment in elderly patients undergoing early invasive strategy for ACS

A disproportionately lower use of cardiovascular medications and invasive treatment in elderly compared to younger patients with ACS is observed, generally due to their fragile health status (i.e. comorbidities), diffuse coronary artery disease, increasing peri-procedural complications and greater incidence of drug-related side-effects. Thus, the optimal antiplatelet drug treatment and the need for prompt revascularization strategy in elderly patients are still debated.

Prolonged immunochemotherapy with rituximab, cytarabine and fludarabine added to cyclophosphamide, doxorubicin, vincristine and prednisolone and followed by rituximab maintenance in untreated elderly patients with mantle cell lymphoma: a prospective study by the Finnish Lymphoma Group

There is no consensus on treatment strategies for elderly patients with mantle cell lymphoma (MCL). In this prospective phase II study we investigated whether the poor outcome could be improved, with reasonable toxicity, by prolonging the immunochemotherapy. Ten cycles of alternating cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP)/cytarabine (AraC) with eight doses of rituximab (R) were given as induction. The potential synergism of intermediate-dose AraC and fludarabine was tested in cycles 6–8. Induction was followed by bimonthly rituximab maintenance for 2 years. The median age of the 60 included patients was 74 years, and the Mantle Cell Lymphoma International Prognostic Index (MIPI) was intermediate or high risk in 98% of the patients. The overall response rate was 95% (complete response/complete response unconfirmed 87%). The response of 11 patients improved with cycles 6–8 (R-fludarabine-AraC). Progression-free survival was 70% and overall survival 72% at 4 years, respectively. Treatment related mortality was 2%. Severe infections were rare, with only one grade 4 infection. More dose reductions were needed during fludarabine-containing courses as compared to R-AraC. In 20 patients a transient grade 4 neutropenia without severe infections was recorded during maintenance. In conclusion, elderly patients with MCL can be treated relatively intensively with acceptable toxicity.

Adjuvant capecitabine chemotherapy using a tailored-dose strategy in elderly patients with colon cancer

This study was conducted to analyze the feasibility of adjuvant capecitabine therapy using a tailored-dose escalation strategy in elderly patients with colon cancer (CC). CC patients (≥ 70 years of age) who received adjuvant capecitabine were enrolled. The starting dosage of capecitabine was 2000 mg/m(2)/day (days 1-14, every 3 weeks). On the second cycle, the dosage was escalated to 2500 mg/m(2)/day if the patient tolerated the first cycle. Dose intensity (DI), toxicity, and the change in quality of life (QoL) were evaluated. Of 82 patients enrolled, 67 completed eight cycles. Dose escalation to 2500 mg/m(2)/day was possible in 56 patients, and this dosage was maintained in 24 patients until the completion of chemotherapy (eight cycles). Forty-one patients completed therapy with a DI ≥ 1333 mg/m(2)/day [relative dose intensity (RDI) ≥ 80%]. Toxic effects were tolerable and the QoL was not compromised during treatment. Creatinine clearance < 50 ml/min and Charlson-Age comorbidity index ≥ 8 were related to a reduced capecitabine dosage (RDI < 80%). A tailored-dose escalation strategy was feasible in elderly CC patients receiving adjuvant capecitabine chemotherapy. Decreased renal function and an increased number of comorbidities were independently predictive of reduced administration of the capecitabine dose.

Predictors of treatment in acute coronary syndromes in the elderly

Management of elderly patients with acute coronary syndromes (ACS) is not standardized and physicians discretion for invasive versus conservative strategies lacks sufficient evidence. The purpose of this analysis was, therefore, to evaluate treatment strategies and outcomes of elderly patients with ACS and to highlight reasons for the treatment decision in a consecutive series of elderly patients. This is a retrospective analysis of 1,001 elderly patients (>75 years) presenting with ACS. Patients were identified on the basis of their final discharge diagnosis. Baseline data, past medical history, cardiac and noncardiac concomitant diseases, treatment strategy, and adverse outcomes were evaluated, using patient's charts. Various co-variates were used to determine the association or predictive value of these co-variates to the invasive versus conservative management of the subjects. Thirty-day mortality and long-term survival were assessed either directly or in discharged patients via telephone interview with the patients, the patients' relatives or the primary care physicians. A total of 776 (77.5%) patients were treated invasively and 225 (22.5%) conservatively. Logistic regression analysis revealed that patients with advanced age, Killip class > II, pre-existing coronary artery disease, prior stroke, pre-existing renal failure, obesity, non-ST-elevation myocardial infarction, prior ACS, and the presence of supraventricular arrhythmias were significantly more likely to undergo conservative treatment. In-hospital mortality was significantly higher in conservatively treated patients (P < 0.001). In this retrospective analysis, we identified age as the main predictor for a conservative treatment strategy in elderly patients, albeit an invasive strategy was associated with a significantly better outcome.

Age-Adjusted Combined Immunochemotherapy without Radiotherapy in Newly Diagnosed PCNSL – A Phase II Trial of the Nordic Lymphoma Group

Abstract 1602 Patients and Methods:From May 2007 to October 2010, 66 newly diagnosed primary central nervous system lymphoma (PCNSL) patients (M/F ratio 1: 1) were enrolled. Younger patients (≤65 yrs; N=39) received 6 three-weekly cycles of chemotherapy consisting of: high-dose (HD)-methotrexate (MTX) (cycles 1, 2, 4 and 5), HD-cytosine arabinoside (AraC) (cycles 3 and 6) in addition to Rituximab (cycle 1 only), ifosfamide (cycles 1 and 4), cyclophosphamide (cycles 2 and 5), vincristine (cycles 2 and 5), vindesine (cycles 3 and 6), and dexamethasone (all 6 cycles). Depocyte® was delivered intratechally during the HD-MTX cycles. Elderly patients (66–75 yrs; N=27) received an identical Rituximab-containing 1st cycle. Cyclophosphamide and ifosfamide were replaced by temozolamide (cycles 2 to 6), which was also given as maintenance in patients with chemosensitive disease, and vincristine was omitted. No radiotherapy was given. Response was determined after the 2nd, 4th and 6th chemotherapy cycle by cerebral MRI and assessed according to International Primary CNS Lymphoma Coordinating Group criteria. The primary endpoint was overall survival (OS), secondary endpoints were progression-free survival (PFS), overall response rate (ORR), systemic toxicity and neurotoxicity assessed as Mini Mental State Examination (MMSE) and Functional Independence Measure (FIM). Results:The median age was 64 yrs overall, 55 yrs (range 40–65) for younger and 70 yrs (range 66–75 years) for elderly patients. In 56 patients, the International Extranodal Lymphoma Study Group prognostic score was: 0–1 (N=5), 2–3 (N=36) and 4–5 (N=15). In the remaining 10 patients, lumbar puncture was not performed in five and spinal fluid protein concentration not reported in additional five cases. Response assessment after completion of induction treatment was performed in 43 out of 66 patients and showed complete remission (CR/CRu) in 30 patients, partial remission (PR) in 5 and progressive disease (PD) in 8. The ORR was 53 %. In 23 patients, response could not be evaluated due to early progression (n=8), toxic death (n=4), poor performance (n=3), neurotoxicity (n=5), or other causes (n=3). Of the 27 elderly patients, 15 continued to maintenance therapy. Of these, 14 have completed the maintenance schedule. Remission status at month 3 was CR in 13 and PD in 1 patient.With a median follow-up of 11.1 months (range 0.6–40.2) the 3-yr OS was 54.6% with no significant difference between younger and elderly patients (56.4% vs 51.9% respectively, p=0.32). The 3-yr PFS was 35.1% (32.9% in younger and 38.2 % in elderly patients; p=0.96). There were four septic deaths. Grade 3–4 hematological toxicity was seen in 79 % of the patients. Arachnoditis-like symptoms occurred in 13 patients. In all but two patients, the symptoms resolved within less than a week. MMSE and FIM were recorded both before and after therapy in 32 patients. Scores improved in 18 and 20 patients, respectively. Conclusion:In conclusion, the schedule applied in the present study led to a 3 yr PFS of 35%. Surprisingly, no significant outcome difference was found between the younger and the elderly patients. The majority of treatment failures were due to early progressive disease under induction therapy. Although the follow-up of our study is short, de-escalation of induction treatment intensity by introduction of a less toxic agent as temozolomide, and its subsequent use in a maintenance schedule may explain a possible survival benefit of this strategy in elderly patients. Disclosures:No relevant conflicts of interest to declare.

Effects of age on long-term outcomes after a routine invasive or selective invasive strategy in patients presenting with non-ST segment elevation acute coronary syndromes: a collaborative analysis of individual data from the FRISC II - ICTUS - RITA-3 (FIR) trials

ObjectiveTo perform a patient-pooled analysis of a routine invasive versus a selective invasive strategy in elderly patients with non-ST segment elevation acute coronary syndrome.MethodsA meta-analysis was performed of patient-pooled data...

Comparison of post-remission strategies in elderly patients with acute myeloid leukemia in first complete remission

Comparison of post-remission strategies in elderly patients with acute myeloid leukemia in first complete remission

Blutungskomplikationen bei geriatrischen Patienten unter oraler Antikoagulation – Aspekte der Polypragmasie

Oral anticoagulant therapy has been shown to be of benefit also in elderly patients in various therapeutic and prophylactic indications. Despite strong evidence in literature, doctors still refuse to prescribe oral anticoagulants to geriatric patients in daily routine. Main reason for this decision is the fear of secondary bleeding complications. According to clinical trial data, distinct risk factors for bleeding attributed to anticoagulant treatment may be determined: age >70 years, female gender, recurrent bleeding events, alcohol/drug abuse, diabetes, anaemia and polypharmacy. The entire article reveals the literature in Medline and Cochrane Library from 1980 to 2009 including the hits "polypharmacy - anticoagulant treatment - elderly patients". It further highlights risk assessment strategies in elderly patients, and possible pharmacokinetic and -dynamic interactions of drugs co-administered with oral anticoagulants.

First-line gefitinib for elderly patients harboring EGFR mutations.

e18094 Background: Potential treatment strategies for elderly patients (pts) with advanced non-small cell lung cancer (NSCLC) have not been well investigated. Gefitinib has demonstrated clinical be...

Multiple Sclerosis in the Elderly Patient

Multiple sclerosis (MS) is an acquired inflammatory demyelinating disease of the CNS that is typically diagnosed in the second or third decade of life. It is generally believed that over the last few decades the life expectancy of patients with adult onset MS (AOMS) has approached that of the general population as a result of better medical and nursing care. Thus, an increasing number of MS patients are entering or have reached senescence. A second group of elderly patients with MS that may be very different in terms of disease pathogenesis are patients with late onset MS (LOMS). The diagnosis in LOMS patients can be challenging because of a large number of age-associated MS differential diagnoses, atypical presentations, a low index of suspicion and the lack of diagnostic criteria specific to this age group. Also, specific problems these patients encounter have only recently become a focus of attention. Changes in renal and hepatic function with age, in addition to the coexistence of medical co-morbidities, require special attention in the management of elderly patients with MS. In this review we outline the characteristics of senescent AOMS and LOMS patients. In addition, we discuss therapeutic strategies in elderly patients with MS based on our knowledge of immunosenescence and age-associated characteristics of this disorder. Given the overall aging of the population, focusing on these two patient groups appears highly relevant.