Radiotherapy in Geriatric Gynecologic Cancer Patients

radyasyon_onkolojisi_102

Hatice HALİSa , Özlem YETMEN DOĞANb
aSakarya Training and Research Hospital, Clinic of Radiation Oncology, Sakarya, Türkiye
bUniversity of Health Sciences Haydarpaşa Numune Training and Research Hospital, Department of Radiation Oncology, İstanbul, Tükiye

Halis H, Yetmen Doğan Ö. Radiotherapy in geriatric gynecologic cancer patients. In: Metcalfe E, ed. Radiotherapy and Current Developments in Geriatric Cancers. 1st ed. Ankara: Türkiye Klinikleri; 2024. p.52-8.

ABSTRACT
Gynecologic cancers are increasingly common in the elderly population and these patients often struggle with a variety of comorbidities. Radiotherapy plays an important role in the treatment of gynecologic cancers, but its application in geriatric patients requires special attention. Measures such as the Charlson Comorbidity Index and G8 Score can be used to assess the efficacy of radiotherapy and response to radiotherapy in geriatric patients. The Charlson Comorbidity Index objectively assesses overall health status by providing a scoring system based on patients’ age and comorbidities. The G8 Score is used to assess the vital status of elderly individuals. The application of radiotherapy in geriatric patients with gynecological cancer is a complex process that requires an individualized approach. In this process, assessing patients’ general health status should be supported by tools such as the Charlson Comorbidity Index and the G8 Score, so that treatment plans can be more effective and patient-focused.

Keywords: Radiotherapy; uterine cervical neoplasms; endometrial neoplasms; geriatric assessment

Referanslar

  1. Crosbie EJ, Kitson SJ, McAlpine JN, Mukhopadhyay A, Powell ME, Singh N. Endometrial cancer. The Lancet. 2022;399(10333):1412-28. [Crossref]  [PubMed]
  2. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians. 2021;71(3):209-49. [Crossref]  [PubMed]
  3. Sherman ME, Sturgeon S, Brinton LA, Potischman N, Kurman RJ, Berman ML, et al. Risk factors and hormone levels in patients with serous and endometrioid uterine carcinomas. Modern pathology: an official journal of the United States and Canadian Academy of Pathology, Inc. 1997;10(10):963-8.
  4. Maneschi F, Ceccacci I, Perugini A, Pane C, Simeone A, Manicone A. Endometrial cancer: prognostic significance of risk classification based on pre-intraoperative findings. Archives of gynecology and obstetrics. 2012;285:521-7. [Crossref]  [PubMed]
  5. Colombo N, Creutzberg C, Amant F, Bosse T, González-Martín A, Ledermann J, et al. ESMO-ESGO-ESTRO Endometrial Consensus Conference Working Group. ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: Diagnosis, Treatment and Follow-up. Int J Gynecol Cancer. 2016;26(1):2-30. [Crossref]  [PubMed]  [PMC]
  6. Creutzberg CL, Nout RA, Lybeert ML, Wárlám-Rodenhuis CC, Jobsen JJ, Mens JW, et al. PORTEC Study Group. Fifteen-year radiotherapy outcomes of the randomized PORTEC-1 trial for endometrial carcinoma. Int J Radiat Oncol Biol Phys. 2011;81(4):e631-8. [Crossref]  [PubMed]
  7. Nout R, Smit V, Putter H, Juergenliemk-Schulz IM, Jobsen JJ, Lutgens L, et al. Vaginal brachytherapy versus pelvic external beam radiotherapy for patients with endometrial cancer of high-intermediate risk (PORTEC-2): an open-label, non-inferiority, randomised trial. The Lancet. 2010;375(9717):816-23. [Crossref]  [PubMed]
  8. Lachance J, Everett E, Greer B, Mandel L, Swisher E, Tamimi H, et al. The effect of age on clinical/pathologic features, surgical morbidity, and outcome in patients with endometrial cancer. Gynecologic oncology. 2006;101(3):470-5. [Crossref]  [PubMed]
  9. Anic K, Altehoefer C, Krajnak S, Schmidt MW, Schwab R, Linz VC, et al. The preoperative G8 geriatric screening tool independently predicts survival in older patients with endometrial cancer: results of a retrospective single-institution cohort study. J Cancer Res Clin Oncol. 2023;149(2):851-63. [Crossref]  [PubMed]  [PMC]
  10. Metcalfe E, Erkal EY, Alço G, Bakkal BH, Özyiğit G. Evaluation of the Radiation Oncologists' Awareness and Needs about Geriatric Oncology: TROD-13-001 Study. 2023.
  11. Driver JA, Viswanathan AN. Frailty measure is more predictive of outcomes after curative therapy for endometrial cancer than traditional risk factors in women 60 and older. Gynecol Oncol. 2017;145(3):526-30. [Crossref]  [PubMed]  [PMC]
  12. Yavas G, Guler OC, Gultekin M, Oymak E, Yuce Sari S, Yildiz F, et al. Multi-institutional study on the role of post-operative radiotherapy in elderly patients with endometrial cancer. International journal of gynecological cancer: official journal of the International Gynecological Cancer Society. 2023;33(5):719-26. [Crossref]  [PubMed]
  13. Meixner E, Lang K, König L, Sandrini E, Lischalk JW, Debus J, et al. Postoperative Radiotherapy for Endometrial Cancer in Elderly (≥80 Years) Patients: Oncologic Outcomes, Toxicity, and Validation of Prognostic Scores. Cancers. 2021;13(24).6264. [Crossref]  [PubMed]  [PMC]
  14. Dutta SW, Trifiletti DM, Grover S, Boimel P, Showalter TN. Management of elderly patients with early-stage medically inoperable endometrial cancer: Systematic review and National Cancer Database analysis. Brachytherapy. 2017;16(3):526-33. [Crossref]  [PubMed]
  15. Wegner RE, Beriwal S, Heron DE, Richard SD, Kelly JL, Edwards RP, et al. Definitive radiation therapy for endometrial cancer in medically inoperable elderly patients. Brachytherapy. 2010;9(3):260-5. [Crossref]  [PubMed]
  16. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359-86. [Crossref]  [PubMed]
  17. Cohen PA, Jhingran A, Oaknin A, Denny L. Cervical cancer. Lancet. 2019;393(10167):169-182. [Crossref]  [PubMed]
  18. Hammer A, Kahlert J, Gravitt PE, Rositch AF. Hysterectomy-corrected cervical cancer mortality rates in Denmark during 2002-2015: A registry-based cohort study. Acta Obstet Gynecol Scand. 2019;98(8):1063-9. [Crossref]  [PubMed]
  19. Kissel M, Rambeau A, Achkar S, Lecuru F, Mathevet P. Challenges and advances in cervix cancer treatment in elder women. Cancer Treat Rev. 2020; 84:101976. [Crossref]  [PubMed]
  20. National Comprehensive Cancer Network(NCCN). Clinical Practice Guidelines in Oncology. Cervical Cancer. Version 1. 2017.
  21. Morris M, Eifel PJ, Lu J, Grigsby PW, Levenback C, Stevens RE, et al. Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancer. N Engl J Med. 1999;340(15):1137-43. [Crossref]  [PubMed]
  22. Rose PG, Bundy BN, Watkins EB, Thigpen JT, Deppe G, Maiman MA, et al. Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med. 1999;340(15):1144-53. [Crossref]  [PubMed]  [PMC]
  23. Quinn BA, Deng X, Colton A, Bandyopadhyay D, Carter JS, Fields EC. Increasing age predicts poor cervical cancer prognosis with subsequent effect on treatment and overall survival. Brachytherapy. 2019;18(1):29-37. [Crossref]  [PubMed]  [PMC]
  24. Mitchell PA, Waggoner S, Rotmensch J, Mundt AJ. Cervical cancer in the elderly treated with radiation therapy. Gynecol Oncol. 1998;71(2):291-8. [Crossref]  [PubMed]
  25. Sharma C, Deutsch I, Horowitz DP, Hershman DL, Lewin SN, Lu YS, et al. Patterns of care and treatment outcomes for elderly women with cervical cancer. Cancer. 2012;118(14):3618-26. [Crossref]  [PubMed]
  26. Nogueira-Rodrigues A, de Melo AC, Garces AH, Paulino E, Alves FV, Vilaça Mdo N, et al. Patterns of Care and Outcome of Elderly Women Diagnosed With Cervical Cancer in the Developing World. Int J Gynecol Cancer. 2016; 26(7):1246-51. [Crossref]  [PubMed]
  27. Chakraborty S, Geetha M, Dessai S, Patil VM. How well do elderly patients with cervical cancer tolerate definitive radiochemotherapy using RapidArc? Results from an institutional audit comparing elderly versus younger patients. Ecancermedicalscience. 2014;8:484. [Crossref]  [PubMed]  [PMC]
  28. Goodheart M, Jacobson G, Smith BJ, Zhou L. Chemoradiation for invasive cervical cancer in elderly patients: outcomes and morbidity. Int J Gynecol Cancer. 2008;18(1):95-103. [Crossref]  [PubMed]
  29. Sakurai H, Mitsuhashi N, Takahashi M, Yamakawa M, Akimoto T, Hayakawa K, et al. Radiation therapy for elderly patient with squamous cell carcinoma of the uterine cervix. Gynecol Oncol. 2000;77(1):116-20. [Crossref]  [PubMed]
  30. Yin Lin M, Kondalsamy-Chennakesavan S, Bernshaw D, Khaw P, Narayan K. Carcinoma of the cervix in elderly patients treated with radiotherapy: patterns of care and treatment outcomes. J Gynecol Oncol. 2016;27(6):e59. [Crossref]  [PubMed]  [PMC]
  31. Wang YM, Wang CJ, Fang FM, Chen HC, Hsu HC, Huang YJ, et al. Differences in the outcomes and complications between elderly and younger uterine cervical cancer patients treated by definitive radiotherapy - A propensity score-matched study. Gynecol Oncol. 2017;145(2):277-83. [Crossref]  [PubMed]
  32. You KY, Peng HH, Jiang YH, Bi ZF, Qiu XS. Selective use of concurrent chemotherapy in elderly cervical cancer patients treated with definitive radiotherapy: experience from two institutions. Cancer Manag Res. 2019;11: 4815-23. [Crossref]  [PubMed]  [PMC]
  33. Guler OC, Sari SY, Birgi SD, Gultekin M, Yildiz F, Onal C. Definitive Chemoradiotherapy in Elderly Cervical Cancer Patients: A Multiinstitutional Analysis. Int J Gynecol Cancer. 2017;27(7):1446-54. [Crossref]  [PubMed]
  34. Eifel PJ. Chemoradiotherapy in the treatment of cervical cancer. Semin Radiat Oncol. 2006;16:177-85. [Crossref]  [PubMed]
  35. Moore KN, Java JJ, Slaughter KN, Rose PG, Lanciano R, DiSilvestro PA, et al. Is age a prognostic biomarker for survival among women with locally advanced cervical cancer treated with chemoradiation? An NRG Oncology/Gynecologic Oncology Group ancillary data analysis. Gynecol Oncol. 2016; 143(2):294-301. [Crossref]  [PubMed]  [PMC]
  36. Cetin IA, Halis H, Gültekin M, Alanyali S, Ibis K, Sarper B, et al. # 878 Definitive radiotherapy/chemoradiotherapy results in geriatric patients with cervical cancer. BMJ Specialist Journals; 2023. [Crossref]
  37. Vitale SG, Capriglione S, Zito G, Lopez S, Gulino FA, Di Guardo F,et al. Management of endometrial, ovarian and cervical cancer in the elderly: current approach to a challenging condition. Arch Gynecol Obstet. 2019;299(2):299-315. [Crossref]  [PubMed]
  38. Wang C, Yang C, Wang W, Xia B, Li K, Sun F, et al. A prognostic nomogram for cervical cancer after surgery from seer database. J Cancer. 2018;9 (21):3923-8. [Crossref]  [PubMed]  [PMC]
  39. Wang W, Liu X, Meng Q, Zhang F, Hu K. Nomogram for predicting para-aortic lymph node metastases in patients with cervical cancer. Arch Gynecol Obstet. 2018;298(2):381-8. [Crossref]  [PubMed]
  40. Adhikari P, Vietje P, Mount S. Premalignant and malignant lesions of the vagina. Diagn Histopathol. 2017;23:28-34. [Crossref]
  41. Frank SJ, Jhingran A, Levenback C, Eifel PJ. Definitive radiation therapy for squamous cell carcinoma of the vagina. Int J Radiat Oncol Biol Phys. 2005;62:138-47. [Crossref]  [PubMed]
  42. Gadducci A, Fabrini MG, Lanfredini N, Sergiampietri C. Squamous cell carcinoma of the vagina: natural history, treatment modalities and prognostic factors. Crit Rev Oncol Hematol. 2015;93:211-24. [Crossref]  [PubMed]
  43. Yang J, Delara R, Magrina J, Magtibay P, Langstraat C, Dinh T, et al. Management and outcomes of primary vaginal cancer. Gynecol Oncol. 2020;159:456-63. [Crossref]  [PubMed]
  44. Samant R, Lau B, E C, Le T, Tam T. Primary vaginal cancer treated with concurrent chemoradiation using Cis-platinum. Int J Radiat Oncol Biol Phys. 2007;69(3):746-50. [Crossref]  [PubMed]
  45. Beller U, Quinn MA, Benedet JL, Creasman WT, Ngan HY, Maisonneuve P, et al. Carcinoma of the vulva. FIGO 26th Annual Report on the Results of Treatment in Gynecological Cancer. Int J Gynaecol Obstet. 2006;95 Suppl 1:S7-27. [Crossref]
  46. Stuckey A, Schutzer M, Rizack T, Dizon D. Locally advanced vulvar cancer in elderly women: is chemoradiation beneficial? American journal of clinical oncology. 2013;36(3):279-82. [Crossref]  [PubMed]
  47. Swanick CW, Eifel PJ, Huo J, Meyer LA, Smith GL. Challenges to delivery and effectiveness of adjuvant radiation therapy in elderly patients with node-positive vulvar cancer. Gynecol Oncol. 2017;146(1):87-93. [Crossref]  [PubMed]  [PMC]