Radiation therapy in old patients. Side effects and results of radiation therapy in old patients

Background: Despite a growing number of elderly patients receiving radiatio n therapy little is known about side effects and outcome of irradiation in this section of the population. Methods: In a review article epidemiologic data, aspects of radiation-biolo gy as well as side effects and outcome of radiation therapy of elderly pati ents are discussed. Results: Cancer incidence rises with age (Figure 1) and is exceeding 3.5% f or males older than 85 years. With a life expectancy of more than 4 years, curative therapy is indicated even at this age. Furthermore several retrosp ective studies indicate that local control and disease-Specific survival af ter radiation therapy of elderly patients is comparable with that of younge r persons (Tables 3 and 4). The exception contains elderly patients with Gr ade-III to IV gliomas or with rectal carcinoma who show a reduced survival which is perhaps caused by less aggressive combined treatment (tumor resect ion). Although some biological and molecular data indicate ct rise in radiation s ensitivity with growing age like the reduction of the capacity of some DNA- repair enzymes, there is no convincing evidence in animal studies or in ret rospective clinical studies that radiation therapy is generally less well t olerated by older individuals (Tables I and 2). Some age-depending differen ces in organ toxicities are described in 3 large studies, which evaluate th e data of patients who were enrolled in different EORTC-trials: Older patie nts suffer mow of functional mucositis in case of radiation therapy to the head and neck, they have an increased weight loss and a higher frequency of late esophageal damage when irradiated in the thorax, and they show a high er prevalence of sexual dysfunction when treated with radiation therapy to the pelvis. On the other hand younger patients suffer more from acute toxic ity like skin damage, nausea, and deterioration of the performance status d uring pelvic radiotherapy. When discussing the dose intensity of radiation therapy concomitant disease which leads to extensive atherosclerotic vessel damage should be kept in m ind. Old patients should be monitored closely during therapy, since the los s of electrolytes or fluid is often not very well tolerated. Conclusion: The indication to radiation therapy of elderly cancer patients should take into account their performance status as well as the extent and the severity of comorbidity. Age per se is seldom a contraindication for r adiation therapy. Regarding the available data in literature there is no in dication for a dose reduction in radiation therapy only because of age, esp ecially in the curative setting.