Management of The Elderly Cancer Patients Complexity: The Radiation Oncology Potential

Colloca, Giuseppe; Tagliaferri, Luca; Capua, Beatrice Di; Gambacorta, Maria Antonietta; Lanzotti, Vito; Bellieni, Andrea; Monfardini, S.; Balducci, Lodovico; Bernabei, Roberto; Cho, William C.; Valentini, Vincenzo

doi:10.14336/ad.2019.0616

Cited by 15 publications

(9 citation statements)

References 55 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In all our sample, the treatment more frequently proposed was, of course, radiotherapy, since our population belongs to this Unit. The high number of oldest old patients treated with radiotherapy confirms the evidence that this is an ideal therapy for older adults [ 12 , 13 ]. The second more frequent treatment was hormone therapy, because of the large prevalence of breast and prostate cancer.…”

Section: Discussionmentioning

confidence: 73%

Perspectives and limits of cancer treatment in an oldest old population

et al. 2021

Self Cite

View full text Add to dashboard Cite

Background Population of oldest old will grow dramatically in the next future and cancer, physiologically related to aging, will be very prevalent among them. Lack of evidence is a huge problem to manage cancer in oldest old and will be more and more in the next years. Aims Our purpose was to investigate the characteristics of a population of oldest old patients with cancer treated in the Radiation Oncology Unit of Fondazione Policlinico A. Gemelli IRCCS. Methods We conducted a retrospective study. The primary outcome was to evaluate which characteristics of the population could influence the choice of oncological treatment (with radical or non-radical intent). Results We identified a total of 348 patients: 140 were on follow-up; 177 were under treatment; 31 were considered not eligible for treatments. Patients under treatment had a high comorbidity index (mean Charlson Comorbidity Index 5.4), and a high prevalence of polypharmacy (mean number of drugs 5.6). More than half (53.1%) was treated with radical intent. Patients treated with radical intent were 1 year younger (87.1 years old vs 88.1 years old), more performant (ECOG 0.7 vs 1.3), and had less prevalence of metastatic neoplasia (6.4% vs 34.9%); comorbidities and drugs did not show differences in the two groups. Conclusion Oldest old, usually not considered in international guidelines, are treated for oncological disease, often with radical intent. The treatment seems not to be tailored considering comorbidities but on performance status.

show abstract

Section: Discussionmentioning

confidence: 73%

Perspectives and limits of cancer treatment in an oldest old population

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…The CGA approach is considered essential to identify problems that are not immediately evident. Several studies have demonstrated the ability of CGA to identify otherwise unrecognized conditions of vulnerability to support the decision-making of the specialist (oncologist, radiotherapist, surgeon) when estimating the risk of toxicity to prevent said toxicity and preserve the functional performance of patients [ 23 , 24 , 25 , 26 ].…”

Section: Introductionmentioning

confidence: 99%

Different Impact of Definitions of Sarcopenia in Defining Frailty Status in a Population of Older Women with Early Breast Cancer

Bellieni

Fusco

Sánchez³

et al. 2021

JPM

Self Cite

View full text Add to dashboard Cite

Sarcopenia is a geriatric syndrome characterized by losses of quantity and quality of skeletal muscle, which is associated with negative outcomes in older adults and in cancer patients. Different definitions of sarcopenia have been used, with quantitative data more frequently used in oncology, while functional measures have been advocated in the geriatric literature. Little is known about the correlation between frailty status as assessed by comprehensive geriatric assessment (CGA) and sarcopenia in cancer patients. We retrospectively analyzed data from 96 older women with early breast cancer who underwent CGAs and Dual X-ray Absorptiometry (DXA) scans for muscle mass assessment before cancer treatment at a single cancer center from 2016 to 2019 to explore the correlation between frailty status as assessed by CGA and sarcopenia using different definitions. Based on the results of the CGA, 35 patients (36.5%) were defined as frail. Using DXA Appendicular Skeletal Mass (ASM) or the Skeletal Muscle Index (SMI=ASM/height^2), 41 patients were found to be sarcopenic (42.7%), with no significant difference in prevalence between frail and nonfrail subjects. Using the European Working Group on Sarcopenia in Older People (EWGSOP2) definition of sarcopenia (where both muscle function and mass are required), 58 patients were classified as “probably” sarcopenic; among these, 25 were sarcopenic and 17 “severely” sarcopenic. Only 13 patients satisfied both the requirements for being defined as sarcopenic and frail. Grade 3-4 treatment-related toxicities (according to Common Terminology Criteria for Adverse Events) were more common in sarcopenic and frail sarcopenic patients. Our data support the use of a definition of sarcopenia that includes both quantitative and functional data in order to identify frail patients who need tailored treatment.

show abstract

“…In the elderly and frail population, the longer schedule of treatment is related to poor compliance 14 and a moderate hypofractionated proton beam allowed us to condense the overall treatment time. Literature reports that other reasons why the geriatric population tends to decline RT are the idea of being too old to undergo RT treatment, fear of worsened quality of life, loss of independence due to RT-related toxicities, and inadequate communication with the physician.…”

Section: Discussionmentioning

confidence: 99%

Is a tailored strategy using proton beam radiotherapy for reirradiation advantageous for elderly women? A case report

Barcellini

Ditto

Mirandola

et al. 2021

Tumori

View full text Add to dashboard Cite

Background: The management of primary or recurrent vaginal tumours in an aging population is challenging for gynecologic and radiation oncologists. In patients unsuited for surgery and already irradiated on the pelvis, proton beam radiotherapy may be worthwhile due to its ballistic advantages. Case report: We report the case of an 80-year-old woman with a squamous cell carcinoma of the vagina after a history of pelvic radiation and vaginal brachytherapy delivered for a previous endometrial adenocarcinoma. She received proton beam radiotherapy with a complete response after 12 months and mild toxicity. Conclusions: The complexity of reirradiation management in the frail and elderly population requires attention. Efforts should be focused on maintaining autonomy and quality of life in order to improve adherence and clinical compliance to the treatment. In the era of the tailored approach, hadrontherapy can play an important role to minimize toxicity, obtain good local control, and reduce the overall treatment time.

show abstract

Management of The Elderly Cancer Patients Complexity: The Radiation Oncology Potential

Cited by 15 publications

References 55 publications

Perspectives and limits of cancer treatment in an oldest old population

Perspectives and limits of cancer treatment in an oldest old population

Different Impact of Definitions of Sarcopenia in Defining Frailty Status in a Population of Older Women with Early Breast Cancer

Is a tailored strategy using proton beam radiotherapy for reirradiation advantageous for elderly women? A case report

Contact Info

Product

Resources

About