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Onal C, Demirhan B, Elmali A, Guler OC. Definitive radiotherapy in older patients with high-risk prostate cancer: Age should not be a barrier. Radiother Oncol 2025; 208:110904. [PMID: 40288686 DOI: 10.1016/j.radonc.2025.110904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2025] [Accepted: 03/31/2025] [Indexed: 04/29/2025]
Affiliation(s)
- Cem Onal
- Başkent University Faculty of Medicine, Adana Dr Turgut Noyan Research and Treatment Center, Department of Radiation Oncology, Adana, Turkey; Başkent University Faculty of Medicine, Department of Radiation Oncology, Ankara, Turkey.
| | - Birhan Demirhan
- Division of Radiation Oncology, Iskenderun Gelisim Hospital, Hatay, Turkiye
| | - Aysenur Elmali
- Başkent University Faculty of Medicine, Department of Radiation Oncology, Ankara, Turkey
| | - Ozan Cem Guler
- Başkent University Faculty of Medicine, Adana Dr Turgut Noyan Research and Treatment Center, Department of Radiation Oncology, Adana, Turkey
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Kim YH, Jeong JU, Yang JH, Nam TK, Song JY, Yoon MS, Cho S, Ahn SJ. Comparison of definitive radiotherapy outcomes between younger and older patients with high- or very-high-risk prostate cancer. Radiother Oncol 2025; 205:110763. [PMID: 39894260 DOI: 10.1016/j.radonc.2025.110763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Revised: 01/22/2025] [Accepted: 01/27/2025] [Indexed: 02/04/2025]
Abstract
BACKGROUND AND PURPOSE This study aimed to compare the oncologic outcomes of definitive intensity-modulated radiotherapy (IMRT) between younger and older high- or very-high-risk prostate cancer patients using propensity score matching (PSM) and competing risk analysis (CRA). MATERIALS AND METHODS A total of 569 patients were included in this analysis: 265 younger than 75 years (Group A) and 304 aged 75 years or above (Group B). All patients received IMRT with a daily fraction of 2.2 Gy, administered over 34 fractions, resulting in a total dose of 74.8 Gy. The primary outcomes included biochemical-failure-free survival (BCFFS), distant-metastasis-free survival (DMFS), clinical-failure-free survival (CFFS), cancer-specific survival (CSS), and overall survival (OS). PSM was used to balance the groups, employing a full matching method, while CRA distinguished between cancer-specific events and non-cancer-specific events. RESULTS Before PSM, the 7-year BCFFS, DMFS, CFFS, CSS, and OS rates in Groups A and B were 83.0 % vs. 66.7 % (p = 0.011), 84.1 % vs. 68.0 % (p = 0.002), 82.1 % vs. 66.7 % (p = 0.008), 95.6 % vs. 97.3 % (p = 0.704), and 87.4 % vs. 68.6 % (p < 0.001), respectively. After PSM, the 7-year survival rates were comparable between both groups for all outcomes except OS. CRA revealed that cancer-specific events were more frequent in Group A, whereas non-cancer-specific events predominated in Group B. CONCLUSIONS Both PSM and CRA indicated that definitive IMRT can be safely and effectively delivered to older patients with high- or very high-risk prostate cancer, achieving oncologic outcomes comparable to those in younger patients.
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Affiliation(s)
- Yong-Hyub Kim
- Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Jeollanam-do, South Korea
| | - Jae-Uk Jeong
- Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Jeollanam-do, South Korea
| | - Jung-Ho Yang
- Cardio-cerebrovascular Center, Chonnam National University Hospital, Chonnam National University Medical School, Jeollanam-do, South Korea
| | - Taek-Keun Nam
- Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Jeollanam-do, South Korea
| | - Ju-Young Song
- Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Jeollanam-do, South Korea
| | - Mee Sun Yoon
- Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Jeollanam-do, South Korea
| | - Shinhaeng Cho
- Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Jeollanam-do, South Korea
| | - Sung-Ja Ahn
- Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Jeollanam-do, South Korea
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Shaheen H, Salans MA, Mohamad O, Coleman PW, Ahmed S, Roach M. Age 70 +/- 5 Years and Cancer-Specific Outcomes After Treatment of Localized Prostate Cancer: A Systematic Review. Int J Radiat Oncol Biol Phys 2024; 118:672-681. [PMID: 37788716 DOI: 10.1016/j.ijrobp.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/08/2023] [Accepted: 09/13/2023] [Indexed: 10/05/2023]
Abstract
A secondary analysis of 2 randomized Radiation Therapy Oncology Group trials demonstrated that age ≥70 years was a favorable prognostic factor among men treated with external beam radiation therapy (EBRT). In contrast, several series based on men undergoing radical prostatectomy (RP) suggested that older age was an unfavorable prognostic factor. Our study was initiated to determine whether these observations reflect a true but paradoxical underlying age-related treatment-dependent biological phenomenon. We conducted a systematic review (PubMed, January 1, 1999-January 30, 2023) evaluating the effect of age on cancer-specific outcomes after definitive local treatment with either RP or EBRT. Our main objective was to assess possible interactions between age (using a cutoff of 70 +/- 5 years) and treatment type, with regard to adverse cancer-specific outcomes (eg, pathology, biochemical failure, distant metastasis, or prostate cancer-specific survival). Forty-five studies were selected for inclusion in this systematic review, including 30 and 15 studies with patients treated with RP and EBRT, respectively. Among patients treated with RP, 10 (50%) of these studies suggested that older age was associated with worse outcome(s) after RP. None suggested that age was a favorable prognostic factor after RP. Among the EBRT-based studies, 8 (53%) suggested that older age was associated with better outcomes, with an additional 3 studies (21%) trending to support a better outcome. None of these studies involving EBRT suggested that older age was an adverse prognostic factor. This systematic review suggests that age using a categorical cutoff of 70 +/- 5 years may be an adverse prognostic factor for men undergoing RP but a favorable prognostic factor for men treated with EBRT. Further research is needed to validate these findings.
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Affiliation(s)
- Haitham Shaheen
- Clinical Oncology, Suez Canal University Hospital, Ismailia, Egypt
| | - Mia A Salans
- Department of Radiation Oncology, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Osama Mohamad
- Department of Genitourinary Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Pamela W Coleman
- Division of Urology, Department of Surgery, Howard University Hospital, Washington, DC
| | - Soha Ahmed
- Clinical Oncology Department, Suez University, Suez, Egypt
| | - Mack Roach
- Department of Radiation Oncology, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California.
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4
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Marotte D, Chand-Fouche ME, Boulahssass R, Hannoun-Levi JM. Irradiation of localized prostate cancer in the elderly: A systematic literature review. Clin Transl Radiat Oncol 2022; 35:1-8. [PMID: 35492872 PMCID: PMC9046879 DOI: 10.1016/j.ctro.2022.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 04/14/2022] [Accepted: 04/16/2022] [Indexed: 11/17/2022] Open
Abstract
Oncological benefit for elderly patients with optimal treatment. Elderly patients often received inadequate treatment. Elderly comorbidities can influence oncological outcomes and treatment tolerance. Optimal curative treatment after oncogeriatric assessment. Purpose To analyze the literature that addresses radiation therapy for intermediate and high-risk prostate cancer (PC) in the elderly. Patients and methods A PubMed literature search was conducted including articles from 01/01/2000 to 30/06/21, with the following keywords: PC, radiotherapy/brachytherapy and elderly. The analysis mainly focused on the issue of under-treatment in the elderly and the benefit/risk balance of irradiation. Results Of the 176 references analyzed, 24 matched the selection criteria. The definition of “elderly patient” varied from 70 to 80 years. The analysis was impacted by the inhomogeneous primary end points used in each cohort. Age was often an obstacle to radical treatment, with a subsequent risk of under-treatment, particularly in patients with a poorer prognosis. However, comparable elderly oncological outcomes were compared to younger patients, both with external beam radiotherapy alone or combined with brachytherapy boost. Late toxicity rates are low and most often comparable to younger populations. However, a urinary over- toxicity was observed in the super-elderly (>80 years) after brachytherapy boost. The use of ADT should be considered in light of comorbidities, and may even be deleterious in some patients. Conclusion Due to the increase in life expectancy, the management of PC in the elderly is a challenge for patients, clinicians and health insurance payers. Except for unfit men, elderly patients remain candidates for optimal curative treatment (i.e. regardless of age) after oncogeriatric assessment. More solid data from prospective trials conducted specially in this population will provide better guidance in our daily clinical practice.
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Affiliation(s)
- Delphine Marotte
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Côte d’Azur, 33 avenue Valombrose, 06189 Nice Cedex 2, Nice, France
| | - Marie-Eve Chand-Fouche
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Côte d’Azur, 33 avenue Valombrose, 06189 Nice Cedex 2, Nice, France
| | - Rabia Boulahssass
- Geriatric Coordination Unit for Geriatric Oncology (UCOG) PACA Est, CHU de NICE, University of Cote d’Azur, Oncoage Nice, France
| | - Jean-Michel Hannoun-Levi
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Côte d’Azur, 33 avenue Valombrose, 06189 Nice Cedex 2, Nice, France
- Corresponding author at: Department of Radiation Oncology, Antoine Lacassagne Cancer Center – University Cote d’Azur, 33 Avenue Valombrose, 06107 Nice CEDEX, France.
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Marotte D, Gal J, Schiappa R, Gautier M, Boulahssass R, Chand-Fouche ME, Hannoun-Levi JM. High-Dose-Rate brachytherapy boost for elderly patients with intermediate to high-risk prostate cancer: 5-year clinical outcome of the PROSTAGE cohort. Clin Transl Radiat Oncol 2022; 35:104-109. [PMID: 35692263 PMCID: PMC9184865 DOI: 10.1016/j.ctro.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/01/2022] [Accepted: 05/12/2022] [Indexed: 12/02/2022] Open
Abstract
Intermediate/high risk elderly prostate cancer benefits less from received standards of care. Age is an independent factor for disease control and tolerance. Brachytherapy boost remains efficient and feasible in the elderly. Careful discussion for super elderly patients (>80 y) is warranted. Oncogeriatric assessment is necessary to identify best candidates. Purpose To analyze the oncological outcome in elderly (>70 years) prostate cancer after high-dose rate brachytherapy (HDB) boost. Materials/methods In this retrospective study, patients with intermediate (IR) and high-risk (HR) prostate cancer underwent external beam radiation therapy (EBRT) followed by HDB boost with/without androgen deprivation therapy (ADT). The impact of age (≤70y vs. > 70y) was investigated. Oncological outcome focused on biochemical relapse-free survival (bRFS), cause-specific (CSS) and overall survival (OS). Late genito-urinary (GU) and gastro-intestinal (GI) toxicities were investigated. Results From 07/08 to 01/22, 518 pts received a HDB boost, and 380 were analyzed (≤70y:177pts [46.6%] vs. > 70y:203pts [53.4%]). Regarding NCCN classification, 98 pts (≤70y: 53pts; >70y: 45pts; p = 0.107) and 282 pts (≤70y: 124pts; >70y: 158pts; p = NS) were IR and HR pts respectively. Median EBRT dose was 46 Gy [37.5–46] in 23 fractions [14–25]. HDB boost delivered a single fraction of 14/15 Gy (79%). ADT was used in 302 pts (≤70y: 130pts; >70y: 172pts; p = 0.01). With MFU of 72.6 months [67–83] for the whole cohort, 5-y bRFS, 5-y CSS and 5-y OS were 88% [85–92], 99% [97–100] and 94% [92–97] respectively; there was no statistical difference between the two age groups except for 5-y CSS (p = 0.05). Late GU and GI toxicity rates were 32.4% (G ≥ 3 7.3%) and 10.1% (no G3) respectively. Conclusions For IR and HR prostate cancers, HDB boost leads to high rates of disease control with few late G ≥ 3 GU/GI toxicities. For elderly pts, HDB boost remains warranted mainly in HR pts, while competing comorbidity factors influence OS.
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Pepin A, Pernia M, Danner MT, Ayoob M, Yung TM, Lei S, Collins BT, Simeng S, Aghdam N, Collins SP. Impact of Age on Patient-Reported Outcomes Following Stereotactic Body Radiation Therapy for Prostate Cancer. Cureus 2021; 13:e13780. [PMID: 33842156 PMCID: PMC8030122 DOI: 10.7759/cureus.13780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose Stereotactic body radiation therapy (SBRT) delivers large radiation doses to the prostate while minimizing exposure to adjacent normal tissues. Large fraction sizes may increase the risks of functional decrements. Elderly men may be at an increased risk of these toxicities due to poor baseline function and hence limited reserve. This study describes patient-reported outcomes following SBRT for clinically localized prostate cancer in the elderly. Methods Between 2007 and 2017, 179 hormone-naive elderly patients (≥ 70 years old) and 210 patients under 70 years old with clinically localized prostate cancer were treated with 35-36.25 Gy SBRT in five fractions utilizing the CyberKnife Radiosurgical System (Accuray Inc.). Quality of life (QOL) was assessed using the Expanded Prostate Index Composite-Short Form (EPIC-26) questionnaire at baseline and at 1, 3, 6, 12, 18, 24, 30, and 36 months following the completion of treatment. EPIC scores range from 0 to 100, with lower values representing worsening symptoms. Results EPIC scores in the elderly cohort mirrored those in the younger cohort. EPIC urinary obstructive/irritative scores declined at one month post-SBRT (mean change from baseline ≥70: -7.9; <70: -11.1) before returning to baseline at three months post-SBRT (mean change from baseline ≥70: -0.4; <70: -1.4). The EPIC urinary incontinence scores declined slowly over the three years following treatment without recovery (mean change from baseline ≥70: -6.6; <70: -4.8). EPIC Bowel scores transiently declined at one month post-SBRT (mean change from baseline ≥70: -8.5; <70: -9.1) and then experienced a second more protracted decline over the next three years without recovery (mean change from baseline ≥70: -4.5; <70: -1.8). Hormonal EPIC scores were not impacted by radiation treatment or age. Older men had lower baseline and post-treatment EPIC sexual summary scores at all time points. However, there was no clinically significant difference in the EPIC sexual bother score between younger and older men at baseline and following treatment. Conclusions In the first three years following treatment, the impact of SBRT treatment on patient-reported outcomes was minimal. Our findings suggest that SBRT for clinically localized prostate cancer should not be deferred in older men solely due to concerns of increased morbidity. Further studies should be conducted to evaluate the impact of age on outcomes or morbidity following SBRT.
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Affiliation(s)
- Abigail Pepin
- Department of Radiation Oncology, George Washington University School of Medicine and Health Sciences, Washington, USA
| | - Monica Pernia
- Department of Geriatrics, George Washington University, Washington, USA
| | - Malika T Danner
- Department of Radiation Medicine, Georgetown University Hospital, Washington, USA
| | - Marilyn Ayoob
- Department of Radiation Medicine, Georgetown University Hospital, Washington, USA
| | - Thomas M Yung
- Department of Radiation Medicine, Georgetown University Hospital, Washington, USA
| | - Siyuan Lei
- Department of Radiation Medicine, Georgetown University Hospital, Washington, USA
| | - Brian T Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington, USA
| | - Suy Simeng
- Department of Radiation Medicine, Georgetown University Hospital, Washington, USA
| | - Nima Aghdam
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Sean P Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington, USA
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7
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Impact of age at diagnosis on overall and disease-free survival in men with prostate cancer following conformal 3D radiation therapy. TUMORI JOURNAL 2018; 98:722-7. [DOI: 10.1177/030089161209800608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and background The impact of age on prostate cancer outcome has been controversial. The aim of the study was to evaluate the role of age on overall survival and disease-free survival in patients affected by prostate cancer when treated with 3D conformal radiation therapy. Methods and study design From 1999 to 2005, 1002 patients with T1–T3 prostate cancer were treated with 3D conformal radiation therapy, delivering a median dose of 75.6, 66.6 and 45 Gy to the prostate, seminal vesicles and pelvic nodes (if necessary), respectively. Patients were divided into four groups (<65, 65–70, 70–75, >75 years) according to age at diagnosis. The relationship between age and both overall survival and disease-free survival was calculated with Kaplan-Meier analysis and the comparison between curves was performed by the logrank test. ROC analysis allowed assessment of the best age cutoff. Results Mean age was 71 ± 6 years (median, 72). Median and mean follow-up was 71.4 and 69 months, respectively. In multivariate analysis, there was no significant difference in the distribution of disease risk between age groups. Analysis demonstrated that older age is a strong positive predictor of survival (odds ratio for stratified patients older than 70 years was <1). In fact, at the 90 month follow-up, overall survival and disease-free survival varied with age, increasing from 85% to 95% and from 78% to 94%, respectively. ROC curve analysis yielded a cutoff age value discriminating overall survival and disease-free survival of 72 years. Conclusions Age is a strong positive predictor of overall survival and disease-free survival, playing a protective role for stratified patients up to 72 years of age.
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Arce P, Lagares JI. CPU time optimization and precise adjustment of the Geant4 physics parameters for a VARIAN 2100 C/D gamma radiotherapy linear accelerator simulation using GAMOS. Phys Med Biol 2018; 63:035007. [PMID: 29256451 DOI: 10.1088/1361-6560/aaa2b0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We have verified the GAMOS/Geant4 simulation model of a 6 MV VARIAN Clinac 2100 C/D linear accelerator by the procedure of adjusting the initial beam parameters to fit the percentage depth dose and cross-profile dose experimental data at different depths in a water phantom. Thanks to the use of a wide range of field sizes, from 2 × 2 cm2 to 40 × 40 cm2, a small phantom voxel size and high statistics, fine precision in the determination of the beam parameters has been achieved. This precision has allowed us to make a thorough study of the different physics models and parameters that Geant4 offers. The three Geant4 electromagnetic physics sets of models, i.e. Standard, Livermore and Penelope, have been compared to the experiment, testing the four different models of angular bremsstrahlung distributions as well as the three available multiple-scattering models, and optimizing the most relevant Geant4 electromagnetic physics parameters. Before the fitting, a comprehensive CPU time optimization has been done, using several of the Geant4 efficiency improvement techniques plus a few more developed in GAMOS.
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Affiliation(s)
- Pedro Arce
- Technology Department, Scientific Instrumentation Division, Medical Applications Unit, Centro de Investigaciones Energéticas, MedioAmbientales y Tecnológicas (CIEMAT), Madrid, Spain
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9
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Hennequin C, Guillerm S, Quero L. [Radiotherapy in elderly patients, recommendations for the main localizations: Breast, prostate and gynaecological cancers]. Cancer Radiother 2015; 19:397-403. [PMID: 26282214 DOI: 10.1016/j.canrad.2015.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 05/21/2015] [Indexed: 11/18/2022]
Abstract
Modifications of radiotherapy indications or schedules because of age could be discussed in view of a different evolution of the disease or because of specific toxicities. One important aim is to decrease the number of hospital transports. For breast cancer, the rate of local relapse after lumpectomy is lower in old patients; moreover, characteristics of the disease are often more favourable (hormonosensitivity, low grade). However, adjuvant irradiation decreases significantly the incidence of breast relapse and must be systematically proposed. Hypofractionnated schedules must be recommended; limited data are available for accelerated partial breast irradiation in old women and these techniques must not be used in routine. For low or intermediate risk prostate cancer, assessment of comorbidities is crucial before considering any invasive treatment. A life expectancy of at least 10 years is required if a curative approach, potentially toxic is proposed. In this case, radiotherapy is often the good choice, giving less sequelae than surgery. The indication of androgen deprivation must take into account cardiovascular and bone history. Management of gynaecological cancers must follow the same recommendations as in young women. Exclusive postoperative brachytherapy must be recommended in early stage endometrial carcinomas. Brachytherapy must be also systematically integrated in the radiotherapy program for cervix cancers, even in old women.
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Affiliation(s)
- C Hennequin
- Service de cancérologie-radiothérapie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefeaux, 75475 Paris, France; Université Paris Diderot, 1, avenue Claude-Vellefeaux, 75475 Paris, France.
| | - S Guillerm
- Service de cancérologie-radiothérapie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefeaux, 75475 Paris, France; Université Paris Diderot, 1, avenue Claude-Vellefeaux, 75475 Paris, France
| | - L Quero
- Service de cancérologie-radiothérapie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefeaux, 75475 Paris, France; Université Paris Diderot, 1, avenue Claude-Vellefeaux, 75475 Paris, France
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10
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Everaerts W, Van Rij S, Reeves F, Costello A. Radical treatment of localised prostate cancer in the elderly. BJU Int 2015; 116:847-52. [DOI: 10.1111/bju.13128] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Wouter Everaerts
- Department of Urology; Royal Melbourne Hospital; Parkville Vic. Australia
- Department of Surgery; Peter MacCallum Cancer Centre; East Melbourne Vic. Australia
| | - Simon Van Rij
- Department of Urology; Royal Melbourne Hospital; Parkville Vic. Australia
- Department of Surgery; Peter MacCallum Cancer Centre; East Melbourne Vic. Australia
| | - Fairleigh Reeves
- Department of Urology; Royal Melbourne Hospital; Parkville Vic. Australia
| | - Anthony Costello
- Department of Urology; Royal Melbourne Hospital; Parkville Vic. Australia
- Epworth Healthcare Richmond; Richmond Vic. Australia
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11
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Abstract
The incidence of prostate cancer increases with age. Current evidence suggests that prostate cancer is under treated in patients aged ≥70 years, despite evidence of efficacy and acceptable toxicity. Radical cystectomy and definitive radiotherapy are often denied owing to fears of post-operative complications and radiotherapy-associated gastrointestinal and genitourinary toxicity. However, modern radical prostatectomy techniques provide excellent clinical outcomes with low perioperative morbidity. Moreover, volume-restricted intensity-modulated radiation therapy is a significant improvement over previous 2D conformal radiotherapy with similar efficacy and lower toxicity. Androgen-deprivation therapy is also under-prescribed among the elderly, owing to concerns of increases in cardiac deaths and osteoporosis acceleration. However, prospective trials have not identified any increase in cardiovascular mortality among elderly men receiving androgen-deprivation therapy compared to age-matched controls. Most patients on androgen deprivation eventually progress to a castration-resistant state. At this stage, the disease still responds to newer agents that target the androgen pathway and to chemotherapy. Among the elderly, chemotherapy is under-prescribed even though it has been demonstrated to be palliative and improve survival. We describe the trends in prostate cancer management in the elderly and the importance of assessing comorbidity status, tumour characteristics, and health status, including a complete geriatric evaluation, before making treatment recommendations.
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Affiliation(s)
- Gautam G Jha
- Division of Haematology, Oncology and Transplantation, University of Minnesota, MMC394, 420 Delaware Street, Minneapolis, MN 55455, USA
| | - Vidhu Anand
- Department of Urologic Surgery, University of Minnesota, MMC394, 420 Delaware Street, Minneapolis, MN 55455, USA
| | - Ayman Soubra
- Department of Urology, University of Minnesota, MMC394, 420 Delaware Street, Minneapolis, MN 55455, USA
| | - Badrinath R Konety
- Department of Urology, University of Minnesota, MMC394, 420 Delaware Street, Minneapolis, MN 55455, USA
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12
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Gacci M, Baldi E, Tamburrino L, Detti B, Livi L, De Nunzio C, Tubaro A, Gravas S, Carini M, Serni S. Quality of Life and Sexual Health in the Aging of PCa Survivors. Int J Endocrinol 2014; 2014:470592. [PMID: 24744780 PMCID: PMC3976934 DOI: 10.1155/2014/470592] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 02/02/2014] [Indexed: 12/19/2022] Open
Abstract
Prostate cancer (PCa) is the most common malignancy in elderly men. The progressive ageing of the world male population will further increase the need for tailored assessment and treatment of PCa patients. The determinant role of androgens and sexual hormones for PCa growth and progression has been established. However, several trials on androgens and PCa are recently focused on urinary continence, quality of life, and sexual function, suggesting a new point of view on the whole endocrinological aspect of PCa. During aging, metabolic syndrome, including diabetes, hypertension, dyslipidemia, and central obesity, can be associated with a chronic, low-grade inflammation of the prostate and with changes in the sex steroid pathways. These factors may affect both the carcinogenesis processes and treatment outcomes of PCa. Any treatment for PCa can have a long-lasting negative impact on quality of life and sexual health, which should be assessed by validated self-reported questionnaires. In particular, sexual health, urinary continence, and bowel function can be worsened after prostatectomy, radiotherapy, or hormone treatment, mostly in the elderly population. In the present review we summarized the current knowledge on the role of hormones, metabolic features, and primary treatments for PCa on the quality of life and sexual health of elderly Pca survivors.
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Affiliation(s)
- Mauro Gacci
- Department of Urology, University of Florence, Careggi Hospital, Viale Gramsci 7, 50121 Florence, Italy
| | - Elisabetta Baldi
- Department of Experimental and Clinical Biomedical Sciences, Section of Clinical Pathophysiology, University of Florence, Italy
| | - Lara Tamburrino
- Department of Experimental and Clinical Biomedical Sciences, Section of Clinical Pathophysiology, University of Florence, Italy
| | - Beatrice Detti
- Radiotherapy, University Hospital Careggi, University of Florence, Italy
| | - Lorenzo Livi
- Radiotherapy, University Hospital Careggi, University of Florence, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, University “La Sapienza”, Rome, Italy
| | - Andrea Tubaro
- Department of Urology, Sant'Andrea Hospital, University “La Sapienza”, Rome, Italy
| | - Stavros Gravas
- Department of Urology, University Hospital of Larissa, Larissa, Greece
| | - Marco Carini
- Department of Urology, University of Florence, Careggi Hospital, Viale Gramsci 7, 50121 Florence, Italy
| | - Sergio Serni
- Department of Urology, University of Florence, Careggi Hospital, Viale Gramsci 7, 50121 Florence, Italy
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13
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Abstract
Elderly men comprise a large percentage of men diagnosed with prostate cancer (PrCa). Although localized PrCa is often indolent, older men tend to be diagnosed with higher-stage disease and are more likely to die from PrCa than younger men. Multiple factors other than age play an important role in determining who will benefit from active treatment, such as comorbid conditions, life expectancy, and tumor characteristics. Careful consideration of such factors can help prevent the overtreatment of elderly men with low-risk disease and undertreatment of elderly men with high-risk disease. Management decisions should be individualized by weighing the benefits of treatment against potential risks and side effects pertinent to the elderly population, whether evaluating for surgery, radiation, or androgen deprivation.
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Affiliation(s)
- Shelly X Bian
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX 77030, USA
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14
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Low-dose rate brachytherapy of the prostate in elderly patients. LA RADIOLOGIA MEDICA 2012; 118:1412-21. [DOI: 10.1007/s11547-012-0872-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 01/03/2012] [Indexed: 10/27/2022]
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Influence of (11)C-choline PET/CT on the treatment planning for salvage radiation therapy in patients with biochemical recurrence of prostate cancer. Radiother Oncol 2011; 99:193-200. [PMID: 21620494 DOI: 10.1016/j.radonc.2011.05.005] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Revised: 04/20/2011] [Accepted: 05/03/2011] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND PURPOSE The present study evaluates the incidence of (11)C-choline PET/CT positive findings in patients with recurrent prostate cancer referred for salvage radiotherapy (SRT) and the influence on the definition of the planning target volume (PTV). MATERIAL AND METHODS Thirty-seven patients treated with radical prostatectomy and referred to SRT to the prostatic fossa because of biochemical relapse, were analysed retrospectively. All patients underwent (11)C-choline PET/CT before radiotherapy. The influence of PET/CT on the extent of the PTV was analysed. The median total follow up after SRT was 51.2 months. RESULTS 11/37 (30%) patients had a positive finding in the (11)C-choline PET/CT, 5 (13%) outside of the prostatic fossa (iliac lymph nodes), implicating an extension of the PTV. Patients with positive (11)C-choline PET/CT had a significant higher PSA value than patients with no pathologic uptake (p=0.03). Overall, at the end of follow up 56% of the patients had a PSA ≤ 0.2ng/ml and 44% had a biochemical relapse of prostate cancer. CONCLUSIONS (11)C-choline PET/CT detects abnormalities outside of the prostatic fossa in 13% of patients referred for SRT because of biochemical relapse after radical prostatectomy, affecting the extent of the PTV. Prospective studies need to be implemented to evaluate the benefit of SRT with a PTV based on (11)C-choline PET/CT.
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La radiothérapie conformationnelle associée à l’hormonothérapie du cancer de prostate localisé : l’âge est-il un facteur limitant ? Prog Urol 2011; 21:333-40. [DOI: 10.1016/j.purol.2010.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Revised: 08/17/2010] [Accepted: 09/15/2010] [Indexed: 11/18/2022]
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Fiorica F, Berretta M, Colosimo C, Berretta S, Ristagno M, Palmucci T, Palmucci S, Lleshi A, Ursino S, Fisichella R, Spartà D, Stefanelli A, Cappellani A, Tirelli U, Cartei F. Safety and efficacy of radiotherapy treatment in elderly patients with localized prostate cancer: A retrospective analysis. Arch Gerontol Geriatr 2010; 51:277-82. [DOI: 10.1016/j.archger.2009.11.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Revised: 11/24/2009] [Accepted: 11/26/2009] [Indexed: 11/29/2022]
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18
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Geinitz H, Thamm R, Mueller T, Jess K, Zimmermann FB, Molls M, Nieder C. Impact of body mass index on outcomes after conformal radiotherapy in patients with prostate cancer. Int J Radiat Oncol Biol Phys 2010; 81:16-22. [PMID: 20864272 DOI: 10.1016/j.ijrobp.2010.05.059] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Revised: 04/07/2010] [Accepted: 05/06/2010] [Indexed: 11/27/2022]
Abstract
PURPOSE Several retrospective analyses have suggested that obese men with prostate cancer treated with external beam radiotherapy (EBRT) have outcomes inferior to those of normal-weight men. However, a recently presented analysis for the first time challenged this association between body mass index (BMI) and treatment failure. It is therefore important to provide further data on this issue. METHODS AND MATERIALS This was a retrospective analysis of 564 men treated with risk-adapted conformal EBRT at a single institution. Low-risk patients received EBRT alone, and the other patients received EBRT plus endocrine treatment. In addition, high-risk patients were treated to higher EBRT doses (74 Gy). A rectal balloon catheter for internal immobilization, which can be identified on portal images, was used in 261 patients (46%). Thus, localization did not rely on bony landmarks alone in these cases. RESULTS The median BMI was 26, and 15% of patients had BMI≥30. Neither univariate nor multivariate analyses detected any significant impact of BMI on biochemical relapse, prostate cancer-specific survival, or overall survival. The 5-year biochemical relapse rate was 21% and prostate cancer-specific survival 96%. CONCLUSIONS The present analysis of a large cohort of consecutively treated patients suggests that efforts to reduce prostate movement and geographic miss might result in comparable outcomes in obese and normal-weight patients.
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Affiliation(s)
- Hans Geinitz
- Department of Radiation Oncology, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany.
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Droz JP, Balducci L, Bolla M, Emberton M, Fitzpatrick JM, Joniau S, Kattan MW, Monfardini S, Moul JW, Naeim A, van Poppel H, Saad F, Sternberg CN. Background for the proposal of SIOG guidelines for the management of prostate cancer in senior adults. Crit Rev Oncol Hematol 2010; 73:68-91. [PMID: 19836968 DOI: 10.1016/j.critrevonc.2009.09.005] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Revised: 09/23/2009] [Accepted: 09/23/2009] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The incidence of prostate cancer increases with age, with a median age at diagnosis of 68 years. Owing to increased life expectancy, the management of prostate cancer in senior adult men (i.e., aged 70 years or older) represents an important public health concern and a major challenge for the future. No specific guidelines have previously been published on the management of prostate cancer in older men. The SIOG has developed a proposal of recommendations in this setting. METHODS A systematic bibliographical search focused on screening, diagnostic procedures, treatment options for localised, locally advanced and metastatic prostate cancer in senior adults was performed. Specific aspects of the geriatric approach were emphasised, including evaluation of health status (nutritional, cognitive, thymic, physical and psycho-social) and screening for vulnerability and frailty. Attention was drawn to the consequences of androgen deprivation and complications of local treatment, mainly incontinence. The collected material has been reviewed and discussed by a scientific panel including urologists, radiation oncologists, medical oncologists and geriatricians from both Europe and North America. RESULTS The consensus is to use either European Association of Urology or National Comprehensive Cancer Network clinical recommendations for prostate cancer treatment and to adapt them to health status based on instrumental activities of daily living (IADL) and activities daily living (ADL), comorbidity evaluation by Cumulative Illness Scoring Rating-Geriatrics and screening for malnutrition. Patients in Group 1 (no abnormality) are 'fit' and should receive the same treatment as younger patients; patients in Group 2 (one impairment in IADL or one uncontrolled comorbidity or at risk of malnutrition) are 'vulnerable' and should receive standard treatment after medical intervention; patients in Group 3 (one impairment in ADL or more than one uncontrolled comorbidity or severe malnutrition) are 'frail' and should receive adapted treatment; patients in Group 4 (dependent) should receive only symptomatic palliative treatment. CONCLUSIONS Treatment of prostate cancer in senior adults should be adapted to health status. Specific prospective studies in this setting are warranted.
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Affiliation(s)
- Jean-Pierre Droz
- Department of Medical Oncology, Centre Léon-Bérard, 69008 Lyon, France.
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Geinitz H, Thamm R, Scholz C, Heinrich C, Prause N, Kerndl S, Keller M, Busch R, Molls M, Zimmermann FB. Longitudinal analysis of quality of life in patients receiving conformal radiation therapy for prostate cancer. Strahlenther Onkol 2009; 186:46-52. [PMID: 20082188 DOI: 10.1007/s00066-009-2023-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Accepted: 09/30/2009] [Indexed: 01/27/2023]
Abstract
PURPOSE To prospectively assess quality of life (QoL) in patients receiving conformal radiation therapy (CRT) for prostate cancer. PATIENTS AND METHODS 78 men with definitive CRT for prostate cancer were entered into the study. Patients were assessed before CRT, at 40 and 60 Gy, and 2, 12 and 24 months after the end of treatment. QoL was assessed using the EORTC Quality of Life Questionnaire C30 and the prostate module PR25. Changes in mean QoL scores with time of >or= 10 points were considered clinically relevant. RESULTS Global QoL did not change statistically significant during CRT and was slightly above baseline levels during follow-up. CRT had a statistically significant negative short-term impact on role functioning, fatigue, and PR25 urinary symptoms. The scores recovered within 2 months to 1 year after CRT. Emotional functioning and social functioning scores slightly increased during and after CRT. Role functioning decreased by > 10 points at 60 Gy and urinary symptoms decreased by > 10 points at 40 and 60 Gy. All other differences were < 10 points. A high number of concomitant diseases and having no children were negative pretreatment predictors for long-term global QoL. CONCLUSION Definitive CRT for prostate cancer does not compromise global QoL during therapy and up to 2 years after treatment. It has a limited negative effect on role functioning, urinary symptoms and, to a lesser extent, on fatigue with restitution within 2 months to 1 year after treatment.
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Affiliation(s)
- Hans Geinitz
- Department of Radiotherapy and Radiooncology, Technische Universität München, München, Germany. .,Klinik und Poliklinik für Strahlentherapie und Radiologische Onkologie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675, München, Germany.
| | - Reinhard Thamm
- Department of Radiotherapy and Radiooncology, Technische Universität München, München, Germany
| | - Christian Scholz
- Department of Radiotherapy and Radiooncology, Technische Universität München, München, Germany
| | - Christine Heinrich
- Department of Radiotherapy and Radiooncology, Technische Universität München, München, Germany
| | - Nina Prause
- Department of Radiotherapy and Radiooncology, Technische Universität München, München, Germany
| | - Simone Kerndl
- Department of Radiotherapy and Radiooncology, Technische Universität München, München, Germany
| | - Monika Keller
- Psychooncology Section, Department of Psychosomatic and General Clinical Medicine, University Hospital, Heidelberg, Germany
| | - Raymonde Busch
- Institute of Medical Statistics and Epidemiology, Technische Universität München, München, Germany
| | - Michael Molls
- Department of Radiotherapy and Radiooncology, Technische Universität München, München, Germany
| | - Frank B Zimmermann
- Department of Radiotherapy and Radiooncology, Technische Universität München, München, Germany
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Richaud P, Salomon L, Mongiat-Artus P, Gaschignard N, Beuzeboc P, Peyromaure M, Bastide C, Cornud F, Molinié V, Rozet F, Staerman F, Soulié M. Place et principes de la radiothérapie dans le cancer de la prostate du sujet âgé. Prog Urol 2009; 19 Suppl 3:S156-9. [DOI: 10.1016/s1166-7087(09)73364-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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22
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23
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Hennequin C, Quéro L. Cancers urologiques du sujet âgé : rôle de la radiothérapie. Prog Urol 2009; 19 Suppl 3:S96-9. [DOI: 10.1016/s1166-7087(09)73352-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Durdux C, Boisserie T, Gisselbrecht M. [Radiation therapy in elderly patients]. Cancer Radiother 2009; 13:609-14. [PMID: 19729331 DOI: 10.1016/j.canrad.2009.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Revised: 06/02/2009] [Accepted: 06/03/2009] [Indexed: 11/17/2022]
Abstract
Cancer is a disease that predominantly occurs in older patients who represent a quarter of the population in western countries. Numerous types of cancer are observed in elderly people. Radiotherapy is one of the most powerful treatment against cancer. Most of published studies have demonstrated feasibility of radiotherapy in curative or palliative intent whatever cancer types are considered. Complete geriatric assessment and a multidisciplinary approach are the key points. The purpose of this review is to highlight sights of radiation oncology specifically related to aging. Particular emphasis is placed on logistic and technical aspects of radiation, as dose, irradiated volume and fractionation.
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Affiliation(s)
- C Durdux
- Service de Radiothérapie, Hôpital Européen Georges-Pompidou, 75015 Paris, France.
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25
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[Prostate cancer: what role for curative radiotherapy in elderly?]. Cancer Radiother 2009; 13:623-7. [PMID: 19695936 DOI: 10.1016/j.canrad.2009.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Revised: 06/03/2009] [Accepted: 06/05/2009] [Indexed: 11/21/2022]
Abstract
PURPOSE Discuss the place of radiotherapy given in a curative intent in elderly patients with localised prostate cancer according to complications, local control, survival observed in a specific and a review of the literature. PATIENTS AND METHODS The cohort consisted of 65 males aged 80 or more with localised prostate cancer who choose radiotherapy as a curative modality. Twelve radiotherapy centres affiliated to the Rare Cancer Network participated to the study. The retrospective analysis was carried out on immediate and late side-effects, biological free of relapse survival and global survival. Multivariate analysis took into account the comorbidities, the initial prostatic specific antigen (PSA) value, the Gleason score and the therapeutic modalities. RESULTS From January 1990 to December 2000, 65 patients were included into the cohort. Mean age was 81 years. The specific series consisted of 10 T1, 40 T2 and 15 T3 N0M0. Median follow up was 65 months. Immediate and late complications were comparable to those described in younger patients who received a similar irradiation. There were no negative impact of the treatment on disease free survival and global survival. Recent literature did suggest analogous results. CONCLUSIONS Radiation therapy with a curative intent should not be systematically withheld in elderly patients with localised prostate cancer.
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26
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Nguyen TD, Azria D, Brochon D, Poortmans P, Miller RC, Scandolaro L, Majewski W, Krengli M, Abacioglu U, Moretti L, Villa S, Akyol F, Jovenin N. Curative external beam radiotherapy in patients over 80 years of age with localized prostate cancer: a retrospective rare cancer network study. Crit Rev Oncol Hematol 2009; 74:66-71. [PMID: 19419885 DOI: 10.1016/j.critrevonc.2009.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Revised: 03/26/2009] [Accepted: 04/02/2009] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To analyse tolerance and outcome of patients over 80 years of age who choose external beam radiation therapy to the prostate as a curative treatment. METHODS AND MATERIAL We evaluated acute and late side effects, biological DFS (bDFS) and actuarial survival as well as causes of death in relation to the clinical status including co-morbidity, PSA value, Gleason score and modalities of external radiotherapy in patients with localised prostate cancer >80 years of age. RESULTS From January 1990 to December 2000, 65 eligible cases (median age: 81) were treated by 12 different participating institutions in the Rare Cancer Network. Tumour stage was T1N0M0, T2N0M0 and T3N0M0 for 10, 40, and 15 patients, respectively. Median follow-up was 65 months (range 22-177). Five-year overall survival rate was 77% with a 5-year bDFS rate of 73%. The incidence of grade 3 early toxicity was 12% and 9% for urinary and digestive tract, respectively. CONCLUSIONS Radiation therapy given with curative intent is well tolerated in this selected group of patients aged over 80 years with localised prostate cancer. Results in terms of survival do not suggest a deleterious impact of this treatment. Therefore the authors recommend that radiation therapy with curative intent should not be withheld in selected elderly patients with localised prostate cancer.
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Affiliation(s)
- Tan Dat Nguyen
- Department of Radiation Oncology, Institute Jean-Godinot, Reims, France.
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27
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Gomez-Millan J. Radiation therapy in the elderly: more side effects and complications? Crit Rev Oncol Hematol 2009; 71:70-8. [PMID: 19144538 DOI: 10.1016/j.critrevonc.2008.11.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2008] [Revised: 09/16/2008] [Accepted: 11/20/2008] [Indexed: 10/21/2022] Open
Abstract
Aging is associated with physiological changes and comorbid illnesses, which may affect an individual's tolerance to radiation. There is the belief that a relationship exists between age and radiation toxicity and therefore non-curative schemes are offered to older patients. Preclinical studies show that normal tissue radiation-induced toxicity differs little with age. In the clinical setting, retrospective and some prospective studies have reported that elderly patients treated with radical radiotherapy alone or in combination with chemotherapy, who do not have comorbidities and retain a good performance status, show a benefit in treatment outcomes. However, an increase in acute effects or a lowered functional tolerance has also been reported. To select candidates for radical treatments, a specific geriatric assessment should be used to stratify elderly patients as a function of the physiological status. Only specifically designed prospective studies can define the role of radiation treatment in elderly patients with different physiological status.
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Affiliation(s)
- Jaime Gomez-Millan
- Hospital Juan Ramón Jiménez, Radiation Oncology Department, Ronda Norte SN. 21005 Huelva, Spain.
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28
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Durdux C, Bauer C. [Radiation therapy in elderly patients]. Cancer Radiother 2008; 12:548-53. [PMID: 18691927 DOI: 10.1016/j.canrad.2008.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Accepted: 07/01/2008] [Indexed: 10/21/2022]
Abstract
Cancer is a disease that predominantly occurs in older patients who represent a quarter of the population in western countries. Numerous types of cancer are observed in elderly people. Radiotherapy is one of the most powerful treatment against cancer. Most of published studies have demonstrated feasibility of radiotherapy in curative or palliative intent whatever cancer types are considered. Complete geriatric assessment and a multidisciplinary approach are the key points. The purpose of this review is to highlight sights of radiation oncology specifically related to aging. Particular emphasis is placed on logistic and technical aspects of radiation. Special techniques are also reviewed that have particular relevance to the treatment of the elderly.
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Affiliation(s)
- C Durdux
- Service de radiothérapie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
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Merrick GS, Wallner KE, Galbreath RW, Butler WM, Brammer SG, Allen ZA, Adamovich E. Prostate brachytherapy in men > or =75 years of age. Int J Radiat Oncol Biol Phys 2008; 72:415-20. [PMID: 18374514 DOI: 10.1016/j.ijrobp.2008.01.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2007] [Revised: 12/27/2007] [Accepted: 01/03/2008] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate cause-specific survival (CSS), biochemical progression-free survival (bPFS), and overall survival (OS) in prostate cancer patients aged > or =75 years undergoing brachytherapy with or without supplemental therapies. METHODS AND MATERIALS Between April 1995 and August 2004, 145 consecutive patients aged > or =75 years underwent permanent prostate brachytherapy. Median follow-up was 5.8 years. Biochemical progression-free survival was defined by a prostate-specific antigen level < or =0.40 ng/mL after nadir. Patients with metastatic prostate cancer or hormone-refractory disease without obvious metastases who died of any cause were classified as dead of prostate cancer. All other deaths were attributed to the immediate cause of death. Multiple clinical, treatment, and dosimetric parameters were evaluated for impact on survival. RESULTS Nine-year CSS, bPFS, and OS rates for the entire cohort were 99.3%, 97.1%, and 64.5%, respectively. None of the evaluated parameters predicted for CSS, whereas bPFS was most closely predicted by percentage positive biopsies. Overall survival and non-cancer deaths were best predicted by tobacco status. Thirty-seven patients have died, with 83.8% of the deaths due to cardiovascular disease (22 patients) or second malignancies (9 patients). To date, only 1 patient (0.7%) has died of metastatic prostate cancer. CONCLUSIONS After brachytherapy, high rates of CSS and bPFS are noted in elderly prostate cancer patients. Overall, approximately 65% of patients are alive at 9 years, with survival most closely related to tobacco status. We believe our results support an aggressive locoregional approach in appropriately selected elderly patients.
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Affiliation(s)
- Gregory S Merrick
- Schiffler Cancer Center and Wheeling Jesuit University, Wheeling, WV 26003-6300, USA.
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Larsen A, Reitan JB, Aase ST, Hauer-Jensen M. Long-term prognosis in patients with severe late radiation enteropathy: A prospective cohort study. World J Gastroenterol 2007; 13:3610-3. [PMID: 17659712 PMCID: PMC4146801 DOI: 10.3748/wjg.v13.i26.3610] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess persistent symptoms and mortality in a cohort of patients with severe (grade 3-4) radiation enteropathy, 59 patients were followed up after 15-18 years.
METHODS: Fifty-nine patients were prospectively enrolled by twelve surgical departments. Primary malignant disease, radiation therapy and surgical management were recorded at inclusion. The cause of death or persistence of symptoms was examined in public death records or by interview of survivors.
RESULTS: Thirty-nine patients had received radiation therapy for gynaecological cancers, twelve for urological cancers, four for gastrointestinal cancers and four for other malignancies. Forty-five patients (76%) required surgical intervention. Complications occurred in 11 (25%) operated patients. Forty-seven patients had died at the time of follow-up, seven (12%) died as a direct result of radiation enteropathy, while radiation enteropathy contributed to death in an additional seven patients. Four of the twelve surviving patients suffered from chronic debilitating symptoms of radiation enteropathy, while three had moderate symptoms.
CONCLUSION: Patients with severe delayed radiation enteropathy have a high risk of persistence of symptoms after surgery. At least one in ten patients dies from radiation-induced bowel injury.
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Affiliation(s)
- Annette Larsen
- Department of Oncology, Haukeland University Hospital, N-5021 Bergen, Norway.
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Ohneseit PA, Krebiehl G, Dittmann K, Kehlbach R, Rodemann HP. Inhibition of cyclooxygenase-2 activity by celecoxib does not lead to radiosensitization of human prostate cancer cells in vitro. Radiother Oncol 2007; 82:229-38. [PMID: 17207548 DOI: 10.1016/j.radonc.2006.11.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2006] [Revised: 11/29/2006] [Accepted: 11/30/2006] [Indexed: 01/30/2023]
Abstract
PURPOSE To evaluate the potential radiosensitizing effect of the specific COX-2 inhibitor celecoxib (Celebrex) on prostate carcinoma cells in vitro. MATERIALS AND METHODS The influence of celecoxib (concentration range 5 to 75 microM) on radiation-induced cellular and clonogenic survival was investigated in prostate carcinoma cell lines PC-3, DU145, LNCaP and normal prostate epithelial cells (PrEC). Western blot analysis and ELISA were used to determine the impact of radiation alone or radiation combined with celecoxib treatment on COX-2 expression and prostaglandin E2 synthesis. To evaluate induction of celecoxib-induced apoptosis cell cycle analysis has been performed. RESULTS Celecoxib (5, 10 and 25 microM) in combination with single-dose irradiation of 2 Gy induced a significant radiosensitization in normal prostate epithelial cells which could not be observed for any of the prostate carcinoma cell lines investigated. Increased COX-2 protein expression in PC-3 cells was obvious only after IR with 15 Gy, while PGE2 production was elevated following irradiation (2-15 Gy) in a dose-dependent manner. Treatment with celecoxib alone or in combination with IR led to a dose-dependent increase in COX-2 protein expression. Nevertheless pre-treatment with celecoxib caused a marked reduction of radiation-induced enzyme activity as tested at the level of PGE2 production, both in PC-3 and DU145 cells. Following fractionated irradiation with single doses of 2 Gy, elevated COX-2 protein expression as well as enhanced PGE2 production was observed already after the second fraction in PC-3 cells. Pre-treatment with celecoxib reduced the amount of PGE(2) significantly, but not of COX-2 protein. CONCLUSIONS Our data obtained for the human prostate cancer cell lines do not indicate that a marked inhibition of prostaglandin E2 synthesis by celecoxib leads to enhanced radiosensitization. Thus, in terms of radiosensitization the analysed prostate cancer cells can be classified as non-responders to celecoxib treatment.
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Affiliation(s)
- Petra Anna Ohneseit
- Division of Radiobiology and Molecular Environmental Research, Department of Radiation Oncology, University of Tübingen, Germany
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Pinkawa M, Siluschek J, Gagel B, Demirel C, Asadpour B, Holy R, Eble MJ. Influence of the initial rectal distension on posterior margins in primary and postoperative radiotherapy for prostate cancer. Radiother Oncol 2006; 81:284-90. [PMID: 17125866 DOI: 10.1016/j.radonc.2006.10.028] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2006] [Revised: 09/11/2006] [Accepted: 10/25/2006] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND PURPOSE The aim of the study was to define the effect of different rectum fillings in the planning CT study on the posterior clinical target volume (CTV) displacements (PD) in primary and postoperative radiotherapy (RT) for prostate cancer. MATERIALS AND METHODS Fifty patients underwent CT scans in supine position with a full bladder and an empty bladder before RT and at several points in time during the treatment. PD were determined depending on the initial rectum volume (RV), average cross-sectional rectal area (CSA), and the rectal diameter at the level of the bladder neck (RD). RESULTS Posterior CTV motion was not found to be minimal with a particularly small initial rectum filling. Steeply increasing PD resulted for patients with RV>120cm(3), CSA>12cm(2), and RD>4.5cm. While below these critical values a posterior margin of 6mm/9mm allowed to cover 80%/90% of displacements, 18mm/24mm were needed for patients with larger rectum fillings. No correlation of increasing rectum distension with increasing PD was found at the apex level. PD could not be reduced by voiding the bladder. CONCLUSIONS Defining the posterior margin in prostate RT, the initial rectum distension and the superior-inferior CTV level has to be considered. Patients with large initial rectum fillings have preferentially the need for repeated planning CT scans or image-guided RT.
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Affiliation(s)
- Michael Pinkawa
- Department of Radiation Oncology, RWTH Aachen University, Aachen, Germany.
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Abstract
Cancer is the leading cause of death among the elderly. With the dramatic increase in life expectancy, treatment approach of older cancer patients poses major challenges. There is no consensus on treatment guidelines for elderly cancer patients with significant variability among physicians due to concerns for toxicity. The issue is further complicated by a lack of quality data on age-related issues of cancer management. This review highlights important factors relevant to treatment decision making in older cancer patients with special emphasis on radiation therapy for lung, prostate and breast cancer. The potential benefits of recent innovations and emerging radiotherapeutic technologies and their application to elderly cancer patients is also presented.
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Affiliation(s)
- Ajay Sandhu
- Department of Radiation Oncology, University of California San Diego, Moores Comprehensive Cancer Center, 3855 Health Sciences Drive MC 0843, La Jolla CA, 92093–0843, USA
| | - Arno J Mundt
- Department of Radiation Oncology, University of California San Diego, Moores Comprehensive Cancer Center, 3855 Health Sciences Drive MC 0843, La Jolla CA, 92093–0843, USA
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Stasi M, Munoz F, Fiorino C, Pasquino M, Baiotto B, Marini P, Malinverni G, Valdagni R, Gabriele P. Emptying the rectum before treatment delivery limits the variations of rectal dose - volume parameters during 3DCRT of prostate cancer. Radiother Oncol 2006; 80:363-70. [PMID: 16959344 DOI: 10.1016/j.radonc.2006.08.007] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2005] [Revised: 08/04/2006] [Accepted: 08/11/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE To investigate the impact of rectum motion on dose - volume histograms of the rectum including filling and of the wall (DVH and DWH, respectively), during 3D-conformal radiotherapy (3DCRT) for localized prostate cancer. MATERIALS AND METHODS Ten patients received a planning CT scan (CT(0)) and 11-14 CT during 3DCRT for prostate cancer (total CT scans=126). CT images were 3D matched using bony anatomy. A single observer drew the external contours of rectum and rectum wall and the CTV (prostate + seminal vesicles) on CT(0). Patients were asked to empty their rectum before every CT, as generally performed at the Institute for Cancer Research and Treatment (IRCC) before treatment delivery. Bladder was kept full by drinking 500 cm(3) of water 60 min before the scan, according to our protocol. A 4-field box 3DCRT technique was planned and dose statistics/dose - volume histograms of the rectum were calculated for each contour referred to CT(0),CT(1),...,CT(n) for each patient. Average DVHs during treatment were calculated along with their standard deviation (SD(rand)) and compared to the planned DVH. The analyses on the patient population included the assessment of systematic deviation (average difference and SD, named SD(sys)) as well as the average SD(rand) value expressing the random component of organ motion. Rectum shifts were also assessed by anterior and lateral BEV projections. RESULTS As to the rectum, 8/10 patients showed a "better" average DVH than DVH on CT(0). Wilcoxon test showed a statistically significant reduction when correlating the difference Delta between the average DVH during therapy and planning DVH at CT(0): for instance V(70)Delta = -3.6% and p = 0.022, V(50)Delta = -5.5% and p = 0.022, D(med)Delta = -3.2 Gy and p = 0.007. Average values of DVH systematic difference (average difference between planning scan and treatment), standard deviations (SD(sys)) and average standard deviations of the random fluctuation (SD(random)) were -4.0%, 4.7% and 6.6%, respectively. Whilst the fluctuation results were slightly smaller for DWH. Volume analysis showed a slight systematic variation of the rectal volume between planning and treatment BEV. The average rectal volume during therapy was larger than at the planning CT in 8/10 patients. The systematic shifts of the rectal wall between the planning phase and the treatment were rather small, both below and above the flexure. The larger random fluctuation of the rectum shape was found to be in the cranial half (1 SD=4.4 mm). CONCLUSIONS The practice of carefully emptying the rectum during simulation and therapy for prostate cancer, which is a safe and simple procedure, reduces the impact of organ motion on dose - volume parameters of the rectum.
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Affiliation(s)
- Michele Stasi
- S.C. Fisica Sanitaria, Institute for Cancer Research and Treatment (IRCC), Candiolo (Torino), Italy.
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Boehmer D, Maingon P, Poortmans P, Baron MH, Miralbell R, Remouchamps V, Scrase C, Bossi A, Bolla M. Guidelines for primary radiotherapy of patients with prostate cancer. Radiother Oncol 2006; 79:259-69. [PMID: 16797094 DOI: 10.1016/j.radonc.2006.05.012] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2006] [Revised: 05/15/2006] [Accepted: 05/23/2006] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND PURPOSES The appropriate application of 3-D conformal radiotherapy, intensity modulated radiotherapy or image guided radiotherapy for patients undergoing radiotherapy for prostate cancer requires a standardisation of target delineation as well as clinical quality assurance procedures. PATIENTS AND METHODS Pathological and imaging studies provide valuable information on tumour extension. In addition, clinical investigations on patient positioning and immobilisation as well as treatment verification data offer an abundance of information. RESULTS Target volume definitions for different risk groups of prostate cancer patients based on pathological and imaging studies are provided. Available imaging modalities, patient positioning and treatment preparation studies as well as verification procedures are collected from literature studies. These studies are summarised and recommendations are given where appropriate. CONCLUSIONS On behalf of the European Organisation for Research and Treatment of Cancer (EORTC) Radiation Oncology Group this article presents a common set of recommendations for external beam radiotherapy of patients with prostate cancer.
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Affiliation(s)
- Dirk Boehmer
- Klinik f. Strahlentherapie, Universitätsmedizin Berlin, Charité Campus Mitte, Germany.
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Geinitz H, Zimmermann FB, Thamm R, Erber C, Müller T, Keller M, Busch R, Molls M. Late rectal symptoms and quality of life after conformal radiation therapy for prostate cancer. Radiother Oncol 2006; 79:341-7. [PMID: 16733072 DOI: 10.1016/j.radonc.2006.05.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2005] [Revised: 04/19/2006] [Accepted: 05/08/2006] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE This study was carried out in order to analyze the prevalence of late rectal and anal symptoms after conformal radiation therapy for prostate cancer and to assess their association with quality of life. PATIENTS AND METHODS Two-hundred and forty nine patients were interviewed at 24-111 months after definitive conformal radiation therapy of localized prostate cancer with a median dose of 70 Gy. Rectal symptoms and fecal incontinence were evaluated with standardized questionnaires. Quality of life was assessed with the EORTC Quality of Life Questionnaire-C30 and the prostate cancer module PR25. RESULTS Rectal symptoms were mostly intermittent. Daily symptoms occurred in < or =5% of the patients. Incontinence was mostly mild with only 3% of the patients reporting daily incontinence episodes. Quality of life was comparable to that of the male German general population except that cognitive functioning and diarrhea were worse in the study population and pain was worse in the reference population. Global quality of life was associated with fecal incontinence, fecal urge, tenesmus, therapy for rectal symptoms and hormonal therapy for biochemical/clinical recurrence. CONCLUSIONS Rectal symptoms and fecal incontinence after conformal radiation therapy for prostate cancer are mostly intermittent. Fecal incontinence, fecal urge and tenesmus are associated with lower global quality of life levels.
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Affiliation(s)
- Hans Geinitz
- Department of Radiation Oncology, Technical University Munich, Germany.
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Dirix P, Haustermans K, Junius S, Withers R, Oyen R, Van Poppel H. The role of whole pelvic radiotherapy in locally advanced prostate cancer. Radiother Oncol 2006; 79:1-14. [PMID: 16631267 DOI: 10.1016/j.radonc.2006.03.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2005] [Revised: 03/16/2006] [Accepted: 03/21/2006] [Indexed: 12/30/2022]
Abstract
Routine PSA testing has led to diagnosis and treatment of prostate cancer at earlier stages than previously. Earlier and technically-improved treatment, together with escalation of dose has enhanced cure rates. Although, the incidence of nodal metastases is now lower than in pre-PSA days, more extended pelvic lymphadenectomies have shown the actual rate of lymph node involvement to be higher than had been determined from standard radical prostate surgery. As in cancers in other sites, especially in their earlier stages, lymph node metastases may exist in the absence of haematogenous dissemination. This, together with the improved rates of control of the primary prostate tumour, suggests that elective irradiation of early-stage lymph nodes from prostate cancer should enhance survival in a manner analogous to improvements seen with this approach in other cancers. Although, the absolute incidence of positive nodes in locally advanced prostate cancer warrants elective radiotherapy, it is relatively low and the modest improvements to be expected may be undetected in the results of a small trial.
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Affiliation(s)
- Piet Dirix
- Department of Radiation Oncology, University Hospital Gasthuisberg, Leuven, Belgium
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Hölscher T, Bentzen SM, Baumann M. Influence of connective tissue diseases on the expression of radiation side effects: a systematic review. Radiother Oncol 2006; 78:123-30. [PMID: 16445999 DOI: 10.1016/j.radonc.2005.12.013] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2005] [Revised: 12/31/2005] [Accepted: 12/31/2005] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Patient related co-factors may increase the risk of radiation morbidity. Connective tissue diseases (CTD) are among the co-morbidities that are relatively well studied and have been shown to be of potential clinical relevance for radiotherapy. The aim of this systematic review is to quantify the contribution of CTD to the risk of radiation related side effects. PATIENTS AND METHODS Relevant publications reporting the outcome of radiotherapy in patients with CTD were retrieved according to a standardized query and evaluated for their methodology and quality of reporting, using defined quality criteria. A quantitative estimate of the relative risk of developing side effects in patients with CTD was derived from the observed proportions of responders in patients with or without CTD. Risk estimates were synthesized across studies. RESULTS Eight studies which include data of 9-209 patients who had CTD and were treated with radiotherapy were identified and reviewed. Three of these studies included data suited for further quantitative analysis. The test of the uni-directional hypothesis that patients with CTD had an increased risk of late effects after radiotherapy reached statistical significance, the one-tailed P-value being 0.03. The pooled relative risk was 2.0 with 95% confidence interval (0.99, 4.1). CONCLUSIONS CTD is associated with an increased risk of late radiation induced normal tissue reaction. The literature published to date provides some support for this assertion although most of the reports are plagued by methodological weaknesses, thus calling for a large coordinated study.
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Affiliation(s)
- Tobias Hölscher
- Department of Radiotherapy and Radiation Oncology, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Germany
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