Radiotherapy for elder patients aged ≥80 with clinically localized prostate cancer – Brachytherapy enhanced late GU toxicity especially in elderly

Abstract

Background and purpose: Elongation of life expectancy had led to marked increase in number of elderly patients with localized prostate cancer. However, the standard treatment for such patients is not well determined because of a high prevalence of comorbidities and slow growth of prostate cancer. The aim of this study is to examine the feasibility of radiotherapy for elderly patients aged !80 years. Materials and methods: We compared 96 patients aged !80 years and 2333 younger patients (aged 60-79 years) using multi-institutional data included cT1-T4N0M0 prostate cancer treated with 902 external beam radiotherapy (EBRT) and 1527 brachytherapy (BT). Results: The 5-year biochemical failure-free survival rate was similar between elderly !80 years and younger control (91.3% vs. 85.9%, p = 0.6171) (100%, 92.9%, 82.4% and 96.3%, 93.7%, 89% for low, intermediate and high risk group), and for the prostate cancer-specific survival rate (100% and 99.3%, p = 0.6171). The accumulated incidence of late gastrointestinal (GI) at 5 years was also similar between elderly and younger patients (3.5% vs. 2.5%, p = 0.6857). Brachytherapy improved biochemical control rate and reduced GI toxicity compared with EBRT, however, enhanced late genitourinary (GU) toxicity, especially in elderly patients. Elderly received brachytherapy showed highest rate of late GU toxicity grade !2 of 22.1% than the younger counterparts of 12.7% at 5 years, whereas younger patients treated with EBRT had 2.4% and elderly EBRT had 2.7% (p < 0.0001). Conclusion: Elderly patients aged !80 years showed equivalent biochemical control, prostate cancerrelated survival, and gastrointestinal toxicity profiles to younger patients. Meticulous care should be required for brachytherapy enhanced late GU toxicity, especially in elderly patients aged !80 years.

Irradiation of localized prostate cancer in the elderly: A systematic literature review

“…In the first study (>75y), bNED was significantly higher after BT compared to IMRT, particularly for high-risk patients (91.2% vs 73.6%; p = 0.0195) [30] . In the second study (>80y), the authors reported similar 5-y OS in > 80y (MA 81y) and younger patients (MA 71y): 97.8% vs 96.4% (p = 0.4202) [31] .…”

“…With a MFU of 3.3 years, no difference was noted in acute toxicity or in late GI toxicity. (G2: 8% vs 3% p = 0.19) [31] . Nevertheless, the authors reported an increased late G2 GU toxicity (22% vs 8%; p = 0.005) [38] .…”

“…However, late GI toxicities were increased by EBRT (vs BT ± EBRT) and GU toxicities increased in > 80y patients in the BT group. Consequently, age > 80y and BT emerged as independent factors of late G ≥ 2 GU toxicity [31] .…”

“…However Valdivieso et al observed that one in two patients > 80y may be overtreated with a 10-y OS of 47% [32] . Toxicity appears more debatable, with late GU toxicity seemingly increased in the elderly or super-elderly population (>80y) [31] , [38] . Chen et al in their large cohort, reported age as an independent factor in the increase of post-BT GU and GI toxicity, without specifying the modalities (LDR, HDR, dose, volume, urinary implantation status…) [41] .…”

High-dose-rate brachytherapy boost for elderly patients with intermediate to high-risk prostate cancer: 5-year clinical outcome of the PROSTAGE cohort

“…With a MFU of 71.6 months, the authors reported an estimated bRFS and OS at 72 months of 85.7% and 88.3%. Yamazaki et al [30,31] in their two studies comparing younger and elderly pts (>75 y then 80 y) with all risk PC, reported comparable outcomes in the cohorts with no impact of age. However, in a retrospective study including 2701 pts > 80 y treated with BT (77% with IR or HR-PC), Valdivieso R et al [32] analyzed the oncological outcome at 5 and 10 years.…”