COMPLICATIONS OF PELVIC RADIATION-THERAPY FOR GYNECOLOGIC MALIGNANCIES IN ELDERLY WOMEN

The purpose of this study was to determine the frequency and severity of complications following pelvic irradiation in elderly women with gy necologic malignancies. A retrospective analysis was conducted of the 60 women over 65 years of age treated with pelvic radiation therapy fo r cervical (26), endometrial (31) or proximal vaginal (3) cancer at th e UCLA Medical Center between 1978 and 1991. Acute grade 3 to 4 gastro intestinal (GI) complications, using Gynecologic Oncology Group (GOG) criteria occured in three of 60 patients (5%). Chronic complications o ccured in 28 of 49 patients (57%) followed for longer than 3 months af ter radiation therapy. The 3-year actuarial rate of chonic GI and/or g enitourinary (GU) complications was 63% for any grade and 24% for grad es 2, 3 or 4. Twelve of the 14 grade 2-4 chronic complications were GI . The 3-year actuarial chronic complication rate was 45% for GI compar ed to 17% for GU (P=0.01). The median time to occurrence for GI and GU chronic complications was 8 and 19 months, respectively. In multivari ate analysis, two or more pre-existing medical problems (P=0.03) and d ose of external beam radiation therapy greater than or equal to 45 Gy (P=0.07) were associated with the development of a chronic complicatio n. We conclude that moderate to severe intestinal complications are co mmon after pelvic irradiation of elderly women, particularly those wit h two or more pre-existing medical problems. Pelvic radiation therapy should be used judiciously in elderly women.