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Erschienen in: Current Oncology Reports 1/2021

01.01.2021 | Geriatric Oncology (L Balducci, Section Editor)

The Role of Radiation Therapy in the Older Patient

verfasst von: Ammoren Dohm, Roberto Diaz, Ronica H. Nanda

Erschienen in: Current Oncology Reports | Ausgabe 1/2021

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Abstract

Purpose of Review

Older patients represent a unique subgroup of the cancer patient population for which the role of radiation therapy (RT) requires special consideration. This review will discuss many of these considerations as well as various radiation treatment techniques in the context of a variety of disease sites.

Recent Findings

Several recent studies give insight into the management of older cancer patients considering their age, performance status, comorbid conditions, quality of life, genetics, cost, and individual goals. RT plays an evolving and pivotal role in providing optimal care for this population. Recent advances in RT technique allow for more precise treatment delivery and reduced toxicity. Studies evaluating the use of radiation therapy in breast, brain, lung, prostate, rectal, pancreatic, esophageal, and oligometastatic cancer are summarized and discussed in the context of treating the older patient population.

Summary

Individual age, performance and functional status, comorbid conditions, and patients’ objectives and goals should all be considered when presenting treatment options for older patients and age alone should not disqualify patients from curative intent treatments. When possible, hypofractionated courses should be utilized as outcomes are often equivalent and toxicities are reduced. In many cases, RT may be preferable to other treatment options due to decreased toxicity profile and acceptable disease control.
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Zurück zum Zitat Correa DD, Rocco-Donovan M, DeAngelis LM, Dolgoff-Kaspar R, Iwamoto F, Yahalom J, et al. Prospective cognitive follow-up in primary CNS lymphoma patients treated with chemotherapy and reduced-dose radiotherapy. J Neuro-Oncol. 2009;91:315–21.CrossRef Correa DD, Rocco-Donovan M, DeAngelis LM, Dolgoff-Kaspar R, Iwamoto F, Yahalom J, et al. Prospective cognitive follow-up in primary CNS lymphoma patients treated with chemotherapy and reduced-dose radiotherapy. J Neuro-Oncol. 2009;91:315–21.CrossRef
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Zurück zum Zitat Molinaro AM, Hervey-Jumper S, Morshed RA, Young J, Han SJ, Chunduru P, et al. Association of maximal extent of resection of contrast-enhanced and non–contrast-enhanced tumor with survival within molecular subgroups of patients with newly diagnosed glioblastoma [Internet]. JAMA Oncol. 2020:495. Available from:. https://doi.org/10.1001/jamaoncol.2019.6143. Molinaro AM, Hervey-Jumper S, Morshed RA, Young J, Han SJ, Chunduru P, et al. Association of maximal extent of resection of contrast-enhanced and non–contrast-enhanced tumor with survival within molecular subgroups of patients with newly diagnosed glioblastoma [Internet]. JAMA Oncol. 2020:495. Available from:. https://​doi.​org/​10.​1001/​jamaoncol.​2019.​6143.
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Zurück zum Zitat Cao JQ, Fisher BJ, Bauman GS, Megyesi JF, Watling CJ, Macdonald DR. Hypofractionated radiotherapy with or without concurrent temozolomide in elderly patients with glioblastoma multiforme: a review of ten-year single institutional experience. J Neuro-Oncol. 2012;107:395–405.CrossRef Cao JQ, Fisher BJ, Bauman GS, Megyesi JF, Watling CJ, Macdonald DR. Hypofractionated radiotherapy with or without concurrent temozolomide in elderly patients with glioblastoma multiforme: a review of ten-year single institutional experience. J Neuro-Oncol. 2012;107:395–405.CrossRef
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Zurück zum Zitat Lu VM, Kerezoudis P, Brown DA, Burns TC, Quinones-Hinojosa A, Chaichana KL. Hypofractionated versus standard radiation therapy in combination with temozolomide for glioblastoma in the elderly: a meta-analysis. J Neuro-Oncol. 2019;143:177–85 This meta-analysis compared elderly patients treated with hypofractionated RT (hRT) + temozolomide vs standard fractionation + temozolomide. They found that the hypofractionation had similar progression-free survival but a decreased overall survival. The authors suggest the combination of hRT + TMZ is feasible in well-selected elderly GBM cases.CrossRef Lu VM, Kerezoudis P, Brown DA, Burns TC, Quinones-Hinojosa A, Chaichana KL. Hypofractionated versus standard radiation therapy in combination with temozolomide for glioblastoma in the elderly: a meta-analysis. J Neuro-Oncol. 2019;143:177–85 This meta-analysis compared elderly patients treated with hypofractionated RT (hRT) + temozolomide vs standard fractionation + temozolomide. They found that the hypofractionation had similar progression-free survival but a decreased overall survival. The authors suggest the combination of hRT + TMZ is feasible in well-selected elderly GBM cases.CrossRef
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Zurück zum Zitat Arvold ND, Tanguturi SK, Aizer AA, Wen PY, Reardon DA, Lee EQ, et al. Hypofractionated versus standard radiation therapy with or without temozolomide for older glioblastoma patients. Int J Radiat Oncol Biol Phys. 2015;92:384–9.PubMedCrossRef Arvold ND, Tanguturi SK, Aizer AA, Wen PY, Reardon DA, Lee EQ, et al. Hypofractionated versus standard radiation therapy with or without temozolomide for older glioblastoma patients. Int J Radiat Oncol Biol Phys. 2015;92:384–9.PubMedCrossRef
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Zurück zum Zitat Reifenberger G, Hentschel B, Felsberg J, Schackert G, Simon M, Schnell O, et al. Predictive impact of MGMT promoter methylation in glioblastoma of the elderly. Int J Cancer. 2012;131:1342–50.PubMedCrossRef Reifenberger G, Hentschel B, Felsberg J, Schackert G, Simon M, Schnell O, et al. Predictive impact of MGMT promoter methylation in glioblastoma of the elderly. Int J Cancer. 2012;131:1342–50.PubMedCrossRef
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Zurück zum Zitat Malmström A, Grønberg BH, Marosi C, Stupp R, Frappaz D, Schultz H, et al. Temozolomide versus standard 6-week radiotherapy versus hypofractionated radiotherapy in patients older than 60 years with glioblastoma: the Nordic randomised, phase 3 trial. Lancet Oncol. 2012;13:916–26 This phase 3 trial evaluated the optimum palliative treatment glioblastoma as described in the study title. Overall survival was similar between TMZ and hRT. For age 70 or older, survival was better with TMZ and with hRT than with standard RT (HR for TMZ vs standard RT 0.35 [0.21–0.56], p < 0.0001; HR for hRT vs standard RT 0.59 [95% CI 0.37–0.93], p = 0·02). Patients treated with TMZ who had MGMT promoter methylation had longer survival than those without (p = 0.02).PubMedCrossRef Malmström A, Grønberg BH, Marosi C, Stupp R, Frappaz D, Schultz H, et al. Temozolomide versus standard 6-week radiotherapy versus hypofractionated radiotherapy in patients older than 60 years with glioblastoma: the Nordic randomised, phase 3 trial. Lancet Oncol. 2012;13:916–26 This phase 3 trial evaluated the optimum palliative treatment glioblastoma as described in the study title. Overall survival was similar between TMZ and hRT. For age 70 or older, survival was better with TMZ and with hRT than with standard RT (HR for TMZ vs standard RT 0.35 [0.21–0.56], p < 0.0001; HR for hRT vs standard RT 0.59 [95% CI 0.37–0.93], p = 0·02). Patients treated with TMZ who had MGMT promoter methylation had longer survival than those without (p= 0.02).PubMedCrossRef
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Zurück zum Zitat Keime-Guibert F, Chinot O, Taillandier L, Cartalat-Carel S, Frenay M, Kantor G, et al. Radiotherapy for glioblastoma in the elderly. N Engl J Med. 2007;356:1527–35.PubMedCrossRef Keime-Guibert F, Chinot O, Taillandier L, Cartalat-Carel S, Frenay M, Kantor G, et al. Radiotherapy for glioblastoma in the elderly. N Engl J Med. 2007;356:1527–35.PubMedCrossRef
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Zurück zum Zitat Atagi S, Mizusawa J, Ishikura S, Takahashi T, Okamoto H, Tanaka H, et al. Chemoradiotherapy in elderly patients with non-small-cell lung cancer: long-term follow-up of a randomized trial (JCOG0301). Clin Lung Cancer. 2018;19:e619–27 This phase III trial evaluated patients > 70 with stage III NSCLC and randomized them to chemoradiotherapy (CRT) or RT. CRT arm had better overall survival than the RT arm (p = 0.0239).PubMedCrossRef Atagi S, Mizusawa J, Ishikura S, Takahashi T, Okamoto H, Tanaka H, et al. Chemoradiotherapy in elderly patients with non-small-cell lung cancer: long-term follow-up of a randomized trial (JCOG0301). Clin Lung Cancer. 2018;19:e619–27 This phase III trial evaluated patients > 70 with stage III NSCLC and randomized them to chemoradiotherapy (CRT) or RT. CRT arm had better overall survival than the RT arm (p= 0.0239).PubMedCrossRef
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Zurück zum Zitat Bezjak A, Paulus R, Gaspar LE, Timmerman RD, Straube WL, Ryan WF, et al. Efficacy and toxicity analysis of NRG Oncology/RTOG 0813 Trial of stereotactic body radiation therapy (SBRT) for centrally located non-small cell lung cancer (NSCLC). Int J Radiat Oncol Biol Phys Elsevier. 2016;96:S8 This paper evaluates phase II results of NRG/RTOG 0813 evaluating the use of SBRT for T1–2 (< 5 cm) N0M0 centrally located NSCLC in 71 patients treated in either a 12Gy/fraction or 11.5 Gy/fraction cohort. Late toxicities grade 3 or greater attributed to SBRT were acceptable. Two-year overall survival was 70%.CrossRef Bezjak A, Paulus R, Gaspar LE, Timmerman RD, Straube WL, Ryan WF, et al. Efficacy and toxicity analysis of NRG Oncology/RTOG 0813 Trial of stereotactic body radiation therapy (SBRT) for centrally located non-small cell lung cancer (NSCLC). Int J Radiat Oncol Biol Phys Elsevier. 2016;96:S8 This paper evaluates phase II results of NRG/RTOG 0813 evaluating the use of SBRT for T1–2 (< 5 cm) N0M0 centrally located NSCLC in 71 patients treated in either a 12Gy/fraction or 11.5 Gy/fraction cohort. Late toxicities grade 3 or greater attributed to SBRT were acceptable. Two-year overall survival was 70%.CrossRef
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Zurück zum Zitat Videtic GM, Suescun JAG, Stephans KL, Bogart JA, Tian L, Groman A, et al. A phase 2 randomized study of 2 stereotactic body radiation therapy (SBRT) regimens for medically inoperable patients with node-negative, peripheral non-small cell lung cancer. Int J Radiat Oncol Biol Phys Elsevier. 2016;96:S8–9.CrossRef Videtic GM, Suescun JAG, Stephans KL, Bogart JA, Tian L, Groman A, et al. A phase 2 randomized study of 2 stereotactic body radiation therapy (SBRT) regimens for medically inoperable patients with node-negative, peripheral non-small cell lung cancer. Int J Radiat Oncol Biol Phys Elsevier. 2016;96:S8–9.CrossRef
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Zurück zum Zitat Nanda RH, Liu Y, Gillespie TW, Mikell JL, Ramalingam SS, Fernandez FG, et al. Stereotactic body radiation therapy versus no treatment for early stage non-small cell lung cancer in medically inoperable elderly patients: a National Cancer Data Base analysis. Cancer. 2015;121:4222–30.PubMedCrossRef Nanda RH, Liu Y, Gillespie TW, Mikell JL, Ramalingam SS, Fernandez FG, et al. Stereotactic body radiation therapy versus no treatment for early stage non-small cell lung cancer in medically inoperable elderly patients: a National Cancer Data Base analysis. Cancer. 2015;121:4222–30.PubMedCrossRef
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Zurück zum Zitat Cassidy RJ, Patel PR, Zhang X, Press RH, Switchenko JM, Pillai RN, et al. Stereotactic body radiotherapy for early-stage non-small-cell lung cancer in patients 80 years and older: a multi-center analysis. Clin Lung Cancer. 2017;18:551–8.e6 This multicenter study investigated the efficacy, safety, and survival of patients ≥ 80 years old with NSCLC treated with definitive lung SBRT. The study found that definitive lung SBRT for early-stage non-small-cell lung cancer was efficacious and safe in patients ≥ 80 years old. Patients with a KPS of ≥ 75 derived the most benefit from therapy.PubMedPubMedCentralCrossRef Cassidy RJ, Patel PR, Zhang X, Press RH, Switchenko JM, Pillai RN, et al. Stereotactic body radiotherapy for early-stage non-small-cell lung cancer in patients 80 years and older: a multi-center analysis. Clin Lung Cancer. 2017;18:551–8.e6 This multicenter study investigated the efficacy, safety, and survival of patients ≥ 80 years old with NSCLC treated with definitive lung SBRT. The study found that definitive lung SBRT for early-stage non-small-cell lung cancer was efficacious and safe in patients ≥ 80 years old. Patients with a KPS of ≥ 75 derived the most benefit from therapy.PubMedPubMedCentralCrossRef
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Metadaten
Titel
The Role of Radiation Therapy in the Older Patient
verfasst von
Ammoren Dohm
Roberto Diaz
Ronica H. Nanda
Publikationsdatum
01.01.2021
Verlag
Springer US
Erschienen in
Current Oncology Reports / Ausgabe 1/2021
Print ISSN: 1523-3790
Elektronische ISSN: 1534-6269
DOI
https://doi.org/10.1007/s11912-020-01000-y

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