Patient Selection for Radiotherapy in the Elderly Population: The Importance of Performance Status — ASN Events

Patient Selection for Radiotherapy in the Elderly Population: The Importance of Performance Status (#98)

Richard Khor 1 2 , Mathias Bressel 3 , Jo Tedesco 4 , Keen-Hun Tai 2 , David Ball 1 2 , William Rose 5 , Helen Farrugia 6 , Wai-Kuan Yip 3 , Gillian Duchesne 1 2 , Farshad Foroudi 1 2
  1. Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne
  2. Department of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne
  3. Centre for Biostatistics and Clinical Trials, East Melbourne
  4. Radiotherapy Services, Peter MacCallum Cancer Centre, East Melbourne
  5. Information Management, Peter MacCallum Cancer Centre, East Melbourne
  6. Victorian Cancer Registry, Melbourne

Purpose: Elderly patients are often excluded from randomised trials, despite most cancers occurring in this age group. The primary study aim was to assess the tolerability of curative radiotherapy in elderly patients, and identify predictors for poor treatment tolerability (PTT). The secondary aim was to describe the survival of the patient cohort.

Methods: All patients aged over 85 years who received curative radiotherapy between 2000 and 2010 at a large radiation oncology department were included. Radiotherapy treatment details, dose alteration due to tolerability concerns, ECOG performance status (ECOG) and Charlson Comorbidity Index were recorded. PTT was defined as a treatment break, hospital admission during radiotherapy, or early treatment cessation. The incidence of PTT and PTT causation were described. Multivariate analysis was performed to identify predictors for PTT. Survival analysis was conducted using data from the Victorian Cancer Registry.

Results: 329 patients met eligibility criteria. The median age was 87.2. ECOG was 0-1 in 82% of patients. The most commonly treated tumours were breast (18%), rectum (11%), and lung cancer (11%). Concurrent chemotherapy was delivered in 22% of patients. Radiotherapy dose was altered to maintain tolerability in 25% of patients. PTT was observed in 21% of patients, with 18% of patients admitted during radiotherapy, 5% ceasing treatment early, and 5% prescribed a treatment break. Overall, 95% of patients completed the prescribed treatment. The cause for PTT was unrelated to radiotherapy in over 70% cases. Unfavourable ECOG performance was the only significant predictor of PTT, and correlated with poorer survival. The median survival after radiotherapy was 3.4 years, with a median follow-up of 6 years.

Conclusion: Curative radiotherapy in carefully selected patients over the age of 85 is tolerated in the majority of patients. ECOG was the best predictor of treatment tolerability identified in this study. Age should not be the sole criteria used in identifying patients for curative treatment approaches.