Definitive Radiotherapy/Chemoradiotherapy Outcomes and Toxicity Profile in Geriatric Patients With Cervical Cancer: Turkish Society for Radiation Oncology Geriatric Oncology Group Study

Abstract

Background: To investigate the treatment outcomes, prognostic factors for survival and toxicities in patients older than 65 years with cervical cancer who underwent definitive radiotherapy/chemoradiotherapy and compare the treatment outcomes between the older elderly (>= 75 years) and younger elderly (65-74 years) patients. Methods: The clinical records of 458 patients with cervical cancer were retrospectively reviewed. There were 365 (79.7%) patients who received concurrent chemoradiotherapy and 93 (20.3%) patients who received radiotherapy alone. Radiotherapy was in the form of external beam radiotherapy followed by brachytherapy. Clinicopathological factors and treatment strategies were compared between the two age groups. Results: The median age was 71 years (range: 65-91 years). 71% of patients were in the younger elderly group while 29% were in the older elderly group. Concomitant chemotherapy and brachytherapy were more commonly applied to these patients. Median follow-up was 48 months. The overall survival rate was significantly lower in patients in the older elderly group. The 5-year survival rate was 67.3% in the younger age group compared to 46.1% in the older elderly group. Patients demonstrated statistically significantly higher overall survival rates with chemoradiotherapy compared to radiotherapy alone in both age groups. In multivariate analysis, treatment response and lymph node involvement were found to be significant independent prognostic factors for overall survival, cancer-specific survival, distant metastasis-free survival and disease-free survival. Performance status was found to be an additional factor for overall survival and disease-free survival. The type of treatment, whether chemoradiotherapy or radiotherapy alone and age were also found to be significant independent prognostic factors for overall survival. Conclusions: A curative treatment approach in the geriatric group with locally advanced cervical cancer results in high survival rates with a low toxicity profile. In patients whose health status permits, definitive chemoradiotherapy followed by brachytherapy is considered appropriate.