Cervical cancer in the elderly treated with radiation therapy

Objectives. The aim of this study was to evaluate the tolerance and outcome of elderly cervical carcinoma patients treated with radiation therapy (RT) . Methods. Three hundred ninety-eight patients with stage I-III cervical carc inoma treated with definitive RT were analyzed. Patients were divided into nonelderly (ages 35-69) (n = 338) and elderly (ages greater than or equal t o 70) (n = 60) groups. A comparison of patient, tumor and treatment factors , morbidity, and outcome was performed. Median follow-up was 81 months. Results. Elderly patients had a higher rate of comorbid conditions includin g diabetes (P = 0.02), coronary artery disease (P = 0.003), and hypertensio n (P = 0.001) than younger patients. Comorbid conditions in the elderly res ulted in more frequent treatment breaks and less ability to undergo definit ive treatment with intracavitary RT (ICRT). While the 5-year actuarial dise ase-free (DFS) and cause-specific (CSS) survival rates were comparable betw een the two groups, disease recurrence and death from cervical cancer were more common beyond 5 years in the elderly group. When patients not undergoi ng ICRT and those with treatment protraction were excluded, differences in the DFS and CSS curves were no longer evident. The frequency and severity o f acute and chronic sequelae were similar. Conclusions. Elderly cervical carcinoma patients have an equivalent overall outcome following radiation therapy to younger patients when comparable tr eatment is delivered. Age per se is not associated with a higher rate of ac ute or chronic sequelae. Comorbid conditions adversely impacted on the qual ity and delivery of RT in the elderly group and help explain observed diffe rences in outcome based on age. (C) 1998 Academic Press.