EXPERIENCES OF 23 PATIENTS GREATER-THAN-OR-EQUAL-TO-90 YEARS OF AGE TREATED WITH RADIATION-THERAPY

Purpose: To present 23 patients greater than or equal to 90 years old treated with radiotherapy, and to retrospectively evaluate the results of radiotherapy and tolerance in these patients. Methods and Material s: The clinical records of 27 patients over 90 Sears of age who were t reated with radiotherapy at the Department of Radiology, Shinshu Unive rsity Hospital, and eight affiliated general hospitals from 1990 until 1995 were reviewed. The strategy of radiotherapy, was individually pl anned depending on the stage of the disease and performance status (PS ) of the patient; however, it was not modified, based solely on chrono logic age. The overall survival rate and disease-free survival rate me re determined using the Kaplan-Meier method. The Radiation Therapy Onc ology Group scoring criteria of acute and late reactions of radiation therapy were used. Results: This group of patients accounted for 0.37% of all patients treated with radiotherapy in these hospitals. Of thes e, 23 patients in whom cancer was pathologically confirmed and whose f ollow-up data were available for retrospective analysis were included in the final evaluation of data. The age of the 23 patients ranged fro m 90 to 96 years (median 93). Tumor was untreated and in the early sta ge in five patients, locoregionally advanced in 13, recurrent in four, and systemic: in one. Definitive radiation therapy was administered i n 12 patients (13 sites), preoperative intent in one, anti palliative intent in 10. The period of observation ranged from 2.5 to 6 years (me dian 18 months). Seven patients were alive for 15-67 months. Fourteen patients died because of intercurrent diseases or senility associated with active cancer, and two because of senility without evidence of ca ncer. The overall and relapse-free survival rates were 65% and 30% at 1 year and 30% and 21% at 2 gears, respectively. Definitive radiation therapy was completed in 13 of 13 patients (100%), and local control w as attained in 9 of 13 patients at 6 months (62%). Palliative radiatio n therapy was completed as intended in 7 of 11 (64%), and effects of p alliation mere observed in 9 of 11 patients (81%). Acute dermatitis, m ucositis, pharyngitis, esophagitis, and cystitis of grade 23 related t o the definitive radiation therapy were tolerable for the patients wit h good PS. It took 3-7 weeks (median 5) for acute moist desquamation o f six lesions of skin cancer to heal. Depending on the radiation doses , grade 1-2 atrophy of skin and telangiectasia were documented for eig ht patients followed up for more than 1 year. A brief description of r epresentative case is presented. Conclusion: Patients older than 90 Se ars with good PS may tolerate the acute effects of radiotherapy admini stered according to conventional fractionation schedules. Definitive r adiation therapy should be considered, when applicable, even for patie nts older than 90 years. (C) 1998 Elsevier Science Inc.