Non-stereotactic radiotherapy in older cancer patients

Parisi, Silvana; Lillo, Sara; Cacciola, Alberto; Ferini, Gianluca; Valenti, Vito; Viola, Anna; Santacaterina, Anna; Platania, A; Brogna, A.; Tamburella, C.; Pergolizzi, Stefano

doi:10.1016/j.heliyon.2022.e09593

Cited by 4 publications

(5 citation statements)

References 59 publications

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“…Major comorbidities can worsen the course of cancer during RT, affecting prognosis and treatment tolerance; cardiovascular diseases, diabetes, kidney failure, cognitive impairment, depression, anemia, chronic infections, osteoporosis, and pressure ulcers are the most commonly observed diseases [ 19 ]. Hypertension was the most common comorbidity in our patients at 32.1%, followed by diabetes mellitus, coronary artery disease, and multiple comorbidities; however, no statistical effect on frailty was detected.…”

Section: Discussionmentioning

confidence: 99%

“…To enhance tolerance and prevent a treatment interruption that could adversely affect outcomes, the CT dosage may also be reduced. However, for patients with severe functional limitations, alternative treatment approaches such as standalone RT or supportive therapies should be considered [ 19 ]. In addition, during the treatment process, the expectations of the patient and their caregivers regarding the treatment must be considered [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

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The Impact of Radiotherapy on Frailty in Patients Aged 65 and Over

Güzelöz,

Gök Balcı

2023

Cureus

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Introduction and objective Frailty is characterized by the body's increased susceptibility to stressors due to aging and a concurrent decline in its resilience. A dominant hypothesis suggests that oncological interventions may amplify this vulnerability. Consequently, elderly individuals with cancer may pose challenges for conventional treatments. This research sought to assess the effects of radiotherapy (RT) on the frailty of elderly cancer patients by utilizing the Edmonton Frail Scale (EFS). Methods This research was designed as a prospective observational study. Patients aged 65 and older, receiving treatment at the radiation oncology clinic, were asked to complete the EFS form both before and at the end of their RT course. The scores achieved before and after the RT were obtained, and the medical histories of the patients were recorded. The difference between the pre- and post-RT scores was calculated by subtracting the post-RT score from the pre-RT score to determine any increase or decrease in the score. For the statistical evaluations, a suite of tests (including the Shapiro-Wilk test, Kolmogorov-Smirnov test, paired sample t-test, independent t-tests, analysis of variance {ANOVA}, and Pearson correlation) were implemented. All analyses were conducted using the Statistical Package for Social Sciences (SPSS) software (version 29.0) (IBM SPSS Statistics, Armonk, NY). Results From April 2021 to August 2023, a total of 121 patients participated in the study. Out of these, 81 underwent assessments both pre- and post-RT. The median age was 73; the median follow-up period was five months. The predominant diagnoses included prostate cancer, breast cancer, and gynecological malignancies. A significant proportion of patients was diagnosed with stage IV cancer and underwent palliative RT. Post-RT evaluations revealed a decline in scores for some patients, while an increase was observed for others. Certain score variations were statistically significant. Moreover, an inverse correlation was discerned between the RT dose and fraction number and the post-RT EFS score. Conclusion Our research confirmed that a substantial number of patients either experienced a decrease or maintained stability in their EFS scores after RT. This observation suggests that RT might not exacerbate frailty in the elderly in the short term. Nevertheless, to elucidate the long-term impact of RT on frailty, there is a pressing need for a comprehensive assessment correlating EFS scores with survival rates.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Impact of Radiotherapy on Frailty in Patients Aged 65 and Over

Güzelöz,

Gök Balcı

2023

Cureus

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“…Given the excellent performance of easier ultra-hypofractionated RT protocols (without the support of any stereotactic technology) even among frail patients ( 35 , 36 ), one may question the need for SBRT in the scenario described here. However, it is worth noting that an expanded target volume (i.e.…”

Section: Discussionmentioning

confidence: 99%

Considerations on surgery invasiveness and response and toxicity patterns in classic palliative radiotherapy for acrometastases of the hand: a hint for a potential role of stereotactic body radiation therapy? A case report and literature review

Ferini¹,

Zagardo²,

Viola³

et al. 2023

Front. Oncol.

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BackgroundThe rarity of hand acrometastases hampers the consensus-building for their optimal management among the involved oncology professionals. In the current literature, demolitive surgery overcomes the use of palliative radiotherapy, which proved to be ineffective in more than 30% of cases treated with classic palliative dose schemes, carrying also a not negligible radiation-related adverse event rate. Against this background, stereotactic body radiation therapy (SBRT) could emerge as a well-balanced therapeutic option.Case summaryHere we describe the methods and outcomes of a SBRT treatment of a painful and function-limiting hand acrometastasis in a patient with a history of stage IIIB lung adenocarcinoma. We delivered a total dose of 30 Gy in five daily fractions to a soft-tissue metastasis abutting the fifth metacarpal bone through the SBRT protocol generally used for intracranial treatments. A few weeks later, the patient reported a clinical complete response with acrometastasis and pain disappearance, function recovery, and no significant toxicity. The acrometastasis was the first sign of an atypical cancer progression.ConclusionsSBRT for hand acrometastases is feasible and might have the best therapeutic profile among the currently available treatment options for this rare clinical scenario. Larger investigations are needed to confirm the present single-case experience.

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“…19 In the case of MIBC, Stereotactic body radiation therapy (SBRT) is currently rarely used, 20,21 although it represents one of the emerging options in treating both primary tumors and (oligo)metastases with either ablative or palliative intent for patients not eligible for curative treatment. 22,23,24 SBRT targeting macroscopic bladder tumor is distinct from the conventional palliative treatment of the whole bladder in some critical aspects: shortening of the treatment course, partial target volume and the hypofractionation of the dose. These interventions aim to optimize symptom and tumor control while minimizing toxicities, and reducing overall treatment time, augmenting patients' compliance to radiotherapy (RT).…”

Section: Introductionmentioning

confidence: 99%

“…In the case of MIBC, Stereotactic body radiation therapy (SBRT) is currently rarely used, 20 , 21 although it represents one of the emerging options in treating both primary tumors and (oligo)metastases with either ablative or palliative intent for patients not eligible for curative treatment. 22 , 23 , 24 …”

Section: Introductionmentioning

confidence: 99%

Muscle-invasive bladder cancer in elderly and frail people: Is hypofractionated radiotherapy a feasible approach when no other local options are available?

Marvaso,

Vitullo,

Corrao

et al. 2024

Tumori

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Aim: The study aims to report the feasibility and safety of palliative hypofractionated radiotherapy targeting macroscopic bladder tumors in a monocentric cohort of frail and elderly bladder cancer patients not eligible for curative treatments. Methods: Patients who underwent hypofractionated radiotherapy to the gross disease or to the tumor bed after transurethral resection of bladder tumor from 2017 to 2021 at the European Institute of Oncology IRCCS, were retrospectively considered. Schedules of treatment were 30 and 25 Gy in 5 fractions (both every other day, and consecutive days). Treatment response was evaluated with radiological investigation and/or cystoscopy. Toxicity assessment was carried out according to RTOG/EORTC v2.0 criteria. Results: A total of 16 patients were included in the study, of these 11 received hypofractionated radiotherapy on the macroscopic target volume and five on the tumor bed after transurethral resection of bladder tumor. No grade (G) >2 acute toxicities were described after treatment for both groups. Only one patient in the group receiving radiotherapy on the macroscopic disease reported G4 GU late toxicity. Ten patients had available follow-up status (median FU time 18 months), of them six had complete response, one had stable disease, and three had progression of disease. The overall response rate and disease control rate were 60% and 70%, respectively. Conclusion: Our preliminary data demonstrate that palliative hypofractionated radiotherapy for bladder cancer in a frail and elderly population is technically feasible, with an acceptable toxicity profile. These outcomes emphasize the potential of this approach in a non-radical setting and could help to provide more solid indications in this underrepresented setting of patients.

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Non-stereotactic radiotherapy in older cancer patients

Cited by 4 publications

References 59 publications

The Impact of Radiotherapy on Frailty in Patients Aged 65 and Over

The Impact of Radiotherapy on Frailty in Patients Aged 65 and Over

Considerations on surgery invasiveness and response and toxicity patterns in classic palliative radiotherapy for acrometastases of the hand: a hint for a potential role of stereotactic body radiation therapy? A case report and literature review

Muscle-invasive bladder cancer in elderly and frail people: Is hypofractionated radiotherapy a feasible approach when no other local options are available?

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