Survival Time Of Elderly Patients Research Articles

The Nomogram Model and Factors for the Postoperative Mortality of Elderly Patients with Femoral Neck Fracture Undergoing Artificial Hip Arthroplasty: A Single-Institution 6-Year Experience.

Artificial hip arthroplasty (AHA) is widely accepted in elderly patients with femoral neck fractures, but it is associated with high risk of death and various postoperative complications due to old age and accompanying chronic diseases. Therefore, this study aimed to explore the risk factors for death in elderly patients with femoral neck fractures after AHA and to establish a nomogram risk prediction model, which is expected to reveal high-risk patients and improve the postoperative quality of life and survival rate of patients. Elderly patients who underwent AHA for femoral neck fractures in our hospital from September 2014 to May 2021were retrospectively analyzed. These patients were divided into a survival group and a death group according to their clinical outcomes. The following clinical data were recorded for the patients in the two groups: sex, age, underlying diseases, smoking and drinking history, preoperative nutritional risk score (NRS) and American Society of Anesthesiologists (ASA) score, as well as relevant indicators about the operation. These data were subject to univariate analysis and then logistic analysis to determine the risk factors of death. Subsequently, a nomogram risk prediction model was established and further validated with the receiver operating characteristic curve (ROC) and the Hosmer-Lemeshow test. Finally, the effects of predictive risk factors were analyzed using the Kaplan-Meier survival curve. Follow-up was completed by 260 patients, including 206 patients in the survival group and 54 patients in the death group; the overall death rate was 20.77%, and the follow-up time, age, postoperative 1, 3 and 5-year death rates were 3.47 ± 1.93 years, 75.32 ± 9.12 years, 5.77%, 12.51%, and 25.61%, respectively. The top three causes of death in 54 patients were respiratory disease, cerebrocardiovascular disease, and digestive disease, respectively. The logistic analysis indicated that elderly patients with femoral neck fractures, the risk factors for death after AHA were age ≥ 80 years, preoperative NRS ≥ 4, HB ≤ 90 g/L, CR ≥ 110 umol/L, and ASA score ≥ 3, as well as postoperative albumin ≤ 35 g/L, the nomogram was established, and then its predictive performance was successfully validated using the ROC curve (AUC = 0.814, 95% confidence interval = 0.749-0.879) and the Hosmer-Lemeshow test (p = 0.840). Furthermore, Kaplan-Meier survival curve analysis revealed that the abovementioned six indicators were correlated with the post-AHA survival time of elderly patients with femoral neck fractures (pLog Rank < 0.05). Old age, preoperatively high NRS and ASA score, anemia, poor renal function, and postoperative hypoproteinemia are the major risk factors for death in elderly patients with femoral neck fractures after AHA; they are also associated with postoperative survival. Early identification and effective interventions for optimization of modifiable risk factors are recommended to improve the postoperative quality of life and survival rates.

Orthostatic changes in blood pressure and survival in elderly cardiopaths.

The objective of this study was to analyze the association between orthostatic changes in blood pressure and mortality in elderly cardiopath patients. A cohort of 455 elderly cardiopath patients, monitored at a referral outpatient cardiology clinic in Pernambuco, Brazil, from October 2015 to July 2018. The exposure groups were formed according to their orthostatic changes in blood pressure following the requirements of the Brazilian Guidelines for Hypertension. Orthostatic hypotension was present in 46 patients (10.1%), 91 had orthostatic hypertension (20%), and 318 had no orthostatic alterations (69.9%). There were 52 deaths during follow-up. The results demonstrated that there was no statistically significant association between orthostatic hypotension and overall mortality (HR 1.30; 95%CI 0.53-3.14; p=0.567) nor between orthostatic hypertension and overall mortality (HR 0.95; 95%CI 0.65-1.39; p=0.34). Survival in relation to the exposure groups presented no statistically significant difference (p=0.504). There was a low frequency of orthostatic hypotension and a mild high frequency of orthostatic hypertension when compared with previous studies, and no association was observed with overall mortality or with the survival time of elderly patients with heart disease.

Predictors of chemotherapy tolerance and survival benefit in a geriatric patient population with advanced solid tumors.

It is challenging to identify robust elderly patients suitable for systemic chemotherapy. The goal of this study was to ascertain clinical characteristics that may best predict the most benefit of systemic chemotherapy for geriatric patients (aged ≥80 years) with advanced solid tumors. A retrospective cohort study was conducted of advanced solid tumors patients treated with systemic chemotherapy. We divided the patients into chemotherapy tolerant and intolerant groups. We assessed the efficacy, adverse reactions, progression-free survival, and overall survival of patients treated with chemotherapy. We accounted for comorbidities, Eastern Cooperative Oncology Group performance status (PS), activities of daily living (ADL), and routine serologic lab metrics. We compiled survival curves for the two groups, and Cox regression univariate and multivariate analyses were used to identify factors that influenced survival. We included 84 patients in the analyses. Comorbidities ≤3, medications ≤4, ADL score ≥90, and PS score ≤1 were associated with chemotherapy tolerance (P < 0.05). Normal D-Dimer and serum albumin concentrations were associated with chemotherapy tolerance (P < 0.05). The median overall survival was 15.0 months (95% confidence interval [CI]: 12.8 - 17.2) in the tolerant group and 7.0 months (95% CI: 4.3 - 9.7) in the intolerant group (P < 0.05). Thus, most tolerant patients (79.6%) benefited from chemotherapy. PS, ADL, normal albumin, and chemotherapy tolerance were statistically correlated with overall survival (P < 0.05). Some clinical characteristics were associated with chemotherapy tolerance. The overall survival time of elderly patients with good tolerance to chemotherapy was longer.

The FoxO3 Longevity Genotype Is Associated With Better Survival After Acute Myocardial Infarction in Older Patients

Background: Although numerous studies have been published on prognostic factors after a first acute myocardial infarction (AMI) among middle-aged men, little is known about the prognostic factors and genetic determinants for post-AMI elderly patients. Methods: The Kuakini Honolulu Heart Program (KHHP) is a prospective population-based study of cardiovascular disease (CVD) (defined as coronary heart disease (CHD) and stroke) among men of Japanese ancestry living in Hawaii. We identified 141 first AMI patients from participants of the KHHP exam 4 (1991-93) by ECG and/or cardiac enzymes (onset age: 73-96 years). Men who survived more than one year after AMI were followed for mortality from onset of AMI to December 2018 (all were deceased by 28 years of follow-up). All had FOXO3 genotype information available. Quantile regression was used to compare the median survival times of FOXO3-G allele carriers (longevity genotype) with FOXO3-TT homozygotes (common genotype). Results: Adjusting for age at AMI onset, baseline body mass index (BMI) and glucose levels (at exam 4), median survival times differed between FOXO3-G allele carriers and FOXO3-TT homozygotes by 2.1 years (95% CI=0.24-3.95, p=0.027). Adding other known CHD risk factors (i.e. hypertension, etc.) to the model reduced the difference to 2.03 years (95% CI=0.17-3.89, p=0.033). Furthermore, chi-square testing showed the mortality rate from CVD among FOXO3-G allele carriers was significantly lower than that among the common FOXO3-TT genotype. Conclusions: The data suggest that the FOXO3 longevity genotype reduces the risk of dying from CVD and extends survival time of elderly patients with acute myocardial infarction.

Remaining Lifespan of Patients Aged ≥65 Years Receiving Whole-brain Irradiation for Metastases from Cancer of Unknown Primary.

Personalized therapies may improve outcomes in elderly patients with brain metastases from cancer of unknown primary (CUP). To contribute to this strategy, an instrument for judging their survival time was designed. This retrospective study included 53 patients, aged ≥65 years and treated with whole-brain irradiation (WBI) for brain metastases from CUP. The WBI-program, age, gender, Karnofsky performance score (KPS), number of brain metastases and non-cerebral metastases were analyzed. KPS≤60 (p<0.001) and presence of non-cerebral metastases (p=0.003) were significantly associated with unfavorable survival. These factors formed the basis for the prognostic implement; patient-scores of zero (n=23), one (n=21) or two points (n=9) were obtained. Corresponding survival rates at 6-months were 0%, 19% and 56% (p<0.001). With this instrument, it is easier to judge the remaining survival time of elderly patients with brain metastases from CUP. This information should be used when selecting individual treatment- and WBI-programs.

Validation of risk prediction tools in elderly patients who initiate dialysis.

The number of elderly patients with end-stage renal disease on maintenance dialysis therapy is gradually increasing. The elderly population has difficulties in making decisions regarding initiation of dialysis treatment because of their high morbidity and frailty. The purpose of this study was to determine the best prognostic tool in predicting short-term mortality in elderly patients undergoing dialysis. This study is a multicenter retrospective study. We enrolled patients, aged ≥75 years, who began hemodialysis at three university hospitals in Korea from January 2010 to December 2016. We applied two comorbidity-based score tools (Thamer and Wick, each consisting of seven variables) and the Clinical Frailty Scale (CFS, seven scales), which were validated for mortality prediction in elderly incident patients. Patient's information was obtained from electronic medical records in the participating center, and mortality data (up to December 2016) were obtained from the Korean National Statistical Office. Models were compared using the area under the receiver operating characteristic curve. Among the 219 patients enrolled in this study, the 3- and 6-month mortality rates were 31 (14.4%) and 48 (22.4%), respectively. Receiver operating characteristic curve analysis revealed that both score systems and the CFS showed similar performance while predicting 3- and 6-month mortality. The scores from these indices correlated with survival time. Predicting short-term mortality and long-term survival time for elderly patients is possible using the Thamer and Wick scores and the CFS.

Extracorporeal membrane oxygenation in treating elderly patients with acute myocardial infarction complicated with cardiogenic shock: analysis of prognosis and risk factors

Objective To investigate the short-term clinical effect of extracorporeal membrane oxygenation(ECMO)for elderly patients with acute myocardial infarction(AMI)complicated with cardiogenic shock and to analyze its risk factors. Methods Clinical data of 55 elderly patients with AMI complicated with cardiogenic shock admitted into Henan Provincial Chest Hospital from January 2011 to July 2018 were retrospectively analyzed.According to the prognosis, patients were divided into the survival group(n=41)and the death group(n=14). Baseline characteristics were compared between the two groups.The short-term prognosis during hospitalization including use of temporary pacemaker, continuous renal replacement therapy and ventilation treatment and complications were compared.Univariate and multivariate logistic regression analysis were used to assess the risk factors for mortality. Results Of the 55 patients, 30 patients were male(54.5%), with a mean ±SD age of(67.2±5.3)years.The time from admission to ECMO insertion was(8.6±6.3)h, and the support time was(143.2±61.7)h.There were significant differences in diabetes incidence, hemodynamic indexes, renal function, troponin, B-type natriuretic peptide, lactate levels and the Acute Physiology and Chronic Health Enquiry(APACHE-Ⅱ)score between the two groups(P<0.05). The dosage of norepinephrine, dobutamine and other vasoactive agents, and the application frequency of continuous renal replacement therapy, invasive ventilation treatment and intra-aortic balloon counterpulsation during hospitalization were increased in the death group compared with the survival group(P<0.05). Incidence rates of complications including acute kidney injury, infection and multiple organ dysfunction syndrome were higher in death group than in survival group(P<0.05). Multiple logistic regression analysis showed that advanced age, low left ventricular ejection fraction(LVEF), acute kidney injury, infection and multiple organ dysfunction syndrome were risk factors for the short-term mortality(P<0.05). Conclusions The prognosis of elderly patients with AMI complicated with cardiogenic shock are poor.ECMO can significantly improve the hemodynamic indexes, but has no effect on the survival time in elderly patients with AMI complicated with cardiogenic shock.The advanced age, low LVEF, acute kidney injury, infection and multiple organ dysfunction syndrome are risk factors for the short-term mortality. Key words: Shock, cardiogenic; Extracorporeal membrane oxygenation; Risk factor

Comparison of definitive chemoradiotherapy and radiotherapy alone in patients older than 75 years with locally advanced esophageal carcinoma: A retrospective cohort study.

The aim of this study was to evaluate the efficacy and acute toxicity of definitive chemoradiotherapy (CRT) and radiotherapy (RT) alone as initial treatment in patients aged 75 years and older with locally advanced esophageal squamous cell carcinoma (ESCC) who are not eligible for surgery.Between February 2009 and February 2015, 122 patients older than 75 years with locally advanced ESCC were retrospectively reviewed, in whom 52 patients allocated to the CRT group were treated with at least 2 cycles of platinum and 5-fluorouracil, 70 patients allocated to the RT group were treated with RT alone, all patients were received a total radiation dose of 54–66 Gy, with 1.8 or 2-Gy/fraction. Response rate (RR), progression-free survival (PFS), overall survival (OS), and acute toxicities were compared between the 2 different treatment groups.In the CRT group, the median PFS and OS were 15.3 and 24.6 months, while 10.6 and 19.4 months in the RT group (P = .008 and P = .018). The 1-year survival rates of the 2 groups were 78.8% versus 64.3% (P = .081), and the 2-year survival rates were 48.1% and 30.0% (P = .042), respectively. The objective RR was 55.8% in the CRT group with 18 complete response (CR) and 18.6% in the RT group with 13 CR. Acute toxicity in the CRT group was higher than in the RT group, especially the grade 3 to 4 acute toxicities.Compared with RT alone, definitive CRT in the treatment of locally advanced ESCC can prolong the survival time in elderly patients. Definitive CRT should be considered the first-treatment choice for elderly patients like the younger patients who are not eligible for surgery.

Association Between Nutrition Status and Survival in Elderly Patients With Colorectal Cancer.

Aging patients with cancer have a higher risk of mortality and treatment-associated morbidity than younger patients. Nutrition status may play an important role in cancer mortality. We aimed to evaluate the survival time of elderly patients with colorectal cancer and its association with body mass index (BMI), the patient-generated subjective global assessment (PG-SGA), and phase angle (PA). BMI, PG-SGA, and PA were determined for all patients (n = 250) at first assessment. Seventy-one (28.4%) patients were in active oncologic treatment (group 1) and 179 (71.6%) were in remission (group 2). At the time of the analysis, 73 (29.2%) patients had died and 177 (70.8%) were censored. The mean (standard deviation) age was 70.9 (7.49) years; 17.2% were undernourished, 56% normal weight, and 26.8% were overweight. According to the PG-SGA, 35.2% of patients needed some nutrition intervention and 4.4% needed it urgently. The mean PA was 4.94 ± 1°. PG-SGA, tumor stage, and PA differed significantly ( P < .001) between the groups; BMI did not ( P = .459). Severe malnutrition (PG-SGA C), compared with PG-SGA A, was associated with a relative hazard of death of 12.04 (95% confidence interval [CI], 3.43-42.19, P < .001). PA >5° was associated with better prognosis: a relative hazard of 0.456 (95% CI, 0.263-0.792; P < .005). Among elderly patients with colorectal cancer, PA and PG-SGA were prognosis factors. PA >5° was associated with best survival and PG-SGA C with worst survival.

Retrospective Analysis of Treatment Outcomes and Geriatric Assessment in Elderly Malignant Lymphoma Patients.

In recent years, the Comprehensive Geriatric Assessment (CGA), which is used in gerontology to assess functioning in elderly individuals, has been said to be useful in geriatric oncology. Therefore, we examined whether items in the CGA were associated with survival time in elderly patients with non-Hodgkin lymphoma (NHL). We conducted the CGA for 93 patients aged ≥ 65 years who had undergone treatment for NHL retrospectively. The CGA includes activities of daily living, instrumental activities of daily living, mood, cognition, nutrition, and the Charlson comorbidity index. For each category, we divided subjects into a "good" group and a "poor" group. In regard to the Charlson comorbidity index, patients were divided into two groups using different cutoffs to divide the groups; the two groups were established according to the division with the largest significant difference in survival time. Multivariate analysis was then performed with the following prognostic factors affecting survival: all CGA items, NHL classification, stage, performance status, and doxorubicin use/non-use. We also performed similar analysis for 43 diffuse large B-cell lymphoma (DLBCL) patients who had undergone anthracycline treatment. Results are factors affecting survival in NHL cases included comorbidity score ≥ 6 (P < 0.0001), doxorubicin non-use (P = 0.005), and cognitive impairment (P = 0.0488). In cases of DLBCL, survival was affected by comorbidity score ≥ 5 (P = 0.0016). High comorbidity score was strongly associated with survival in both NHL and DLBCL.

Analysis of efficacy and prognosis of induction chemotherapy in 76 elderly patients with acute myeloid leukemia (non-APL)

This study was purposed to investigate the clinical features, diagnosis, treatment and prognosis of elderly patients with acute myeloid leukemia (AML) (non-APL). The clinical data of 76 elderly ( ≥ 60 old years) AML (non-APL) patients from January 2000 to January 2010 were analyzed retrospectively. According to treatment methods,the 76 patients were divided into 2 groups: induction chemotherapy group (51 cases) and best supportive treatment group (25 cases). The patients in induction chemotherapy group received the cytarabine-based induction chemotherapy regimens, including DA, MA, HA, IA and CAG; the patients in best supportive treatment group received supportive treatment including hydroxyurea, blood transfusion and so on. The clinical features, diagnosis, treatment and prognosis between 2 groups were compared. The results showed that the median survival times of patients in induction chemotherapy and best supportive treatment groups were 5 (0.2-89) and 3 (0.1-17) months respectively, there was significantly statistical difference in median survival time between 2 groups(P < 0.01) suggesting that the induction chemotherapy obviously prolonged the survival time of elderly CML patients. The 5 patients in induction chemotherapy group survived more than 60 months, one of them survived more than nine years. After the first cycle of chemotherapy, the complete remission (CR) rate of patients was 19.6% (10/51), partial remission (PR) rate was 19.6% (10/51), the overall response rate (ORR) was 39.2%, the mortality of patients in induction remission stage was 13.7% (7/51) in induction chemotherapy group; no 1 case in best supportive treatment group reached to CR. The CR rate of patients by using MA regimen was 44.4% and its ORR was 55.5%, which was higher than that by using DA, HA, IA and CAG regimens. The median chemotherapy cycles were 3 (1-14). The follow-up found that the 3 months-survival rate of patients was 65% and 42%, the 6 month-survival rate of patients was 43% and 21%, the 1 year-survival rate of patients was 29% and 13%, the 5 year-survival rate of patients was 13% and 0% in induction chemotherapy and best supportive treatment groups respectively, showing that the survival of patients in induction chemotherapy group was better than those in best supportive treatment group. A total of 31 of out 51 cases (60.8%) in induction chemotherapy group not response to the first cycle of chemotherapy, the survival time of these patients was not statistically significantly different from that of patients in best supportive treatment group. It is concluded that the induction chemotherapy can significantly improve the prognosis of elderly patients with AML, and prolong their median survival time. The induction remission rate in elderly patients with AML is lower than that of younger patients. The MA regimen is better than DA, HA, IA and CAG, there is individual difference in the elderly patients with AML, If the first cycle of chemotherapy has not reached to CR or PR, the best supportive treatment may be considered. The low toxicity, efficient and well-tolerated chemotherapy regimens may be chosen to prolong the survival time of the elderly patients with AML (non-APL).

Age is a prognostic factor affecting survival in lung cancer patients

Despite all efforts at management, prognosis of advanced lung cancer is extremely poor, with a median survival time of ~1 year. The number of cancer patients aged >70 years is significantly increased among the cancer patient population. The aim of this study was to investigate the clinical importance of age in lung cancer. Data from 110 patients with histologically confirmed lung cancer, who were treated and followed up in the Institute of Oncology, University of Istanbul, were recorded from medical charts. There were 100 (91%) males with a median age of 59 years (range, 35–88 years). The majority of patients had non-small cell lung cancer (NSCLC; 84%) and metastatic stage (56%). The rate of positive response to chemotherapy was lower in elderly patients (P=0.01) and the incidence of anemia was higher compared with that in younger patients (P=0.02). The majority of mortalities occurred in elderly patients (P=0.01). The median survival time of elderly patients was significantly lower compared with that of younger patients (37.8 vs. 57 weeks; P=0.009). The 1-year survival rates in younger and elderly patients were 67.3 and 42.5%, respectively. In multivariate analysis, elderly patients also had significantly poorer survival (P=0.023). In the group of elderly patients, analyses revealed that significant prognostic factors, including stage of disease and serum lactate dehydrogenase (LDH) levels, were associated with survival. Elderly patients diagnosed with small cell lung cancer had a poorer outcome compared with those with NSCLC (P=0.009), and older patients with elevated serum LDH levels had a shorter survival time compared with those with normal levels (P=0.042). In conclusion, age is one of the major prognostic factors affecting survival in lung cancer patients; therefore, patients should be managed according to age in clinical practice.

Prognostic factors in metastatic pancreatic cancer: Older patients are associated with reduced overall survival

Pancreatic cancer is a major health concern worldwide and, despite the attempts at management, the prognosis of patients with metastatic pancreatic cancer remains poor, with a median survival of a few months. The aim of this study was to identify and evaluate clinicopathological factors and elucidate the clinical significance of patient age for the outcome of metastatic pancreatic cancer. Data from a total of 154 metastatic patients with a histologically confirmed diagnosis of pancreatic cancer, who were treated and followed-up in our clinic, were recorded from medical charts. The patient sample included 102 (66%) males with a median age of 58 years (range, 25–88 years). The majority of the patients had a poor performance status (64%), weight loss of >10% body weight (74%), tumor size of >3 cm (75%) and elevated tumor markers, including carcinoembryonic antigen (CEA) (66%) and carbohydrate antigen 19-9 (CA19-9) (85%). The distributions of prognostic factors depending on patient age were largely identical. The median survival time of patients with metastatic disease was 179 days and the 1-year survival rate was 7%. The median survival time of elderly patients was significantly lower compared to younger patients (148 vs. 198 days, respectively; P=0.039). The 1-year survival rates in elderly and younger patients were 3 and 10%, respectively. In the univariate and multivariate analyses, elderly patients had poorer outcomes compared with younger patients (P=0.04 and 0.05, respectively). In all patients, the univariate analysis demonstrated that similar prognostic factors, including the performance status of the patients and tumor markers, such as serum CEA and CA19-9 levels, were associated with survival. In the multivariate analysis, younger patients with a poor performance status had a significantly shorter overall survival compared to those with a good performance status (P=0.008). However, no significant prognostic factor affecting the outcome was identified in the elderly patients. In conclusion, patient age is a major prognostic factor affecting the survival of patients with metastatic pancreatic cancer and elderly patients without poor prognostic factors may be eligible for the available treatment options.

NOA-08 randomized phase III trial of 1-week-on/1-week-off temozolomide versus involved-field radiotherapy in elderly (older than age 65) patients with newly diagnosed anaplastic astrocytoma or glioblastoma (Methusalem).

LBA2001 Background: The median survival time for elderly patients (pts) with malignant gliomas is in the range of a few months. Radiotherapy (RT) is the standard treatment and superior to best supportive care both with respect to progression-free and overall survival. The benefit derived from surgery and RT is modest, and both treatments are less well tolerated in elderly pts than in the young. The availability of a potentially effective pharmacological agent, temozolomide (TMZ), for malignant glioma, which exhibits a favorable safety profile, necessitated a reconsideration of the widespread therapeutic nihilism with malignant glioma in the elderly. Methods: The NOA-08 trial of the Neurooncology Working Group (NOA) of the German Cancer Society compared standard postsurgical involved-field RT to a dose of 54-60 Gy, in pts with anaplastic astrocytoma or glioblastoma &gt; 65 ys with a Karnofsky performance score ≥ 60, to TMZ in an one week on/one week off schedule at 100 mg/m2 with dose modification in 25 mg steps in both directions. The primary endpoint was the median survival time (OS) during the follow-up in the 12 months after date of operation. The trial sought to demonstrate the non-inferiority of TMZ compared with RT. Regarding a maximal difference of 25% between both treatment arms in OS as being equivalent, 2 x 206 pts were randomized between May 15, 2005 and Nov 2, 2009 in 22 German and one Suisse sites to provide 80% power to achieve significance at a one-sided level of 0.05. Thirty-nine patients were excluded from the intention-to-treat (ITT) population because no therapy was applied (n=22) or withdrawal of informed consent (n=17). Results: All histological diagnoses were centrally confirmed. Pts characteristics were balanced between arms in the ITT population (n=373) except for more resections and more anaplastic astrocytomas in the RT arm. The non-inferiority of TMZ was not shown. In contrast, pts in the TMZ arm had an increased risk of death (HR=1.24 [95% CI: 0.94-1.63]) compared to pts in the RT arm. The rate of adverse and serious adverse events was higher in the TMZ arm. Conclusions: This trial fails to show the non-inferiority of dose-intensified TMZ alone compared with RT alone in the primary treatment of older pts with malignant glioma. Unlike anaplastic glioma in the younger patient population, RT cannot be safely deferred in the treatment of elderly patients with anaplastic astrocytoma or glioblastoma. Whether RT plus TMZ is superior to RT alone, is addressed in the ongoing companion trial conducted by NCIC, EORTC and TROG. [Table: see text] [Table: see text]