Chemoradiation for invasive cervical cancer in elderly patients: outcomes and morbidity

Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City, Iowa, USA.
International Journal of Gynecological Cancer (Impact Factor: 1.95). 12/2007; 18(1):95-103. DOI: 10.1111/j.1525-1438.2007.00967.x
Source: PubMed

ABSTRACT Age may impact survival and treatment in cervical cancer patients. We sought to determine if treatment and survival were different in elderly patients and whether chemoradiation increased morbidity. We performed a retrospective chart review to identify patients treated with definitive radiation therapy at the University of Iowa Hospitals and Clinics between 1997 and 2001. Three hundred sixty-four patients had a new diagnosis of invasive cervical cancer, of which 150 patients were treated with radiation. We excluded patients treated postoperatively or with palliative intent, leaving 96 patients treated with definitive radiation therapy. Patients were divided into two age categories: elderly (>/=65) and nonelderly (<65). We compared these groups with respect to treatment received, morbidity, and survival. Sixty-nine (72%) women were less than 65 years old, and 27 (28%) women were greater than or equal to 65 years old. Chemoradiation was associated with decreased mortality (P < 0.01). The decrease in mortality did not differ between the two age cohorts (all causes: P = 0.66; cancer specific: P = 0.65), nor was there a difference in the complication rate due to chemoradiation (P = 0.70). Although elderly patients were more likely to be diagnosed with nonsquamous histologies (P < 0.01), their odds of receiving chemoradiation were 0.35 (95% CI: 0.13-0.90) times the odds for nonelderly. Elderly cervical cancer patients more often have nonsquamous histology and are likely to receive only radiation therapy compared to younger patients. Treatment with chemoradiation was associated with similar survival increases in both age cohorts. Complication rates between the two were similar. Chemoradiation should be considered in elderly patients with invasive cervical cancer.

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    ABSTRACT: Despite institutional studies that suggest that radical hysterectomy for cervical cancer is well tolerated in the elderly, little population-level data is available on the procedure's outcomes in older women. We performed a population-based analysis to determine the morbidity, mortality, and resource utilization of radical hysterectomy in elderly women with cervical cancer. Patients recorded in the Nationwide Inpatient Sample with invasive cervical cancer who underwent abdominal radical hysterectomy between 1998-2010 were analyzed. Patients were stratified by age: <50, 50-59, 60-69, and ≥70years. We examined the association between age and the outcomes of interest using chi square tests and multivariable generalized estimating equations. A total of 8199 women were identified, including 768 (9.4%) women age 60-69 and 462 (5.6%) women ≥70years of age. All cause morbidity increased from 22.1% in women <50, to 24.7% in those 50-59 years, 31.4% in patients 60-69 years and 34.9% in women >70years of age (P<0.0001). Compared to women<50, those >70 were more likely to have intraoperative complications (4.8% vs. 9.1%, P=0.0003), surgical site complications (10.9% vs. 17.5%, P<0.0001), and medical complications (9.9% vs. 19.5%, P<0.0001). The risk of non-routine discharge (to a nursing facility) was 0.5% in women <50 vs.12.3% in women ≥70 (P<0.0001). Perioperative mortality women ≥70years of age was 30 times greater than that of women <50 (P<0.0001). Perioperative morbidity and mortality are substantially greater in elderly women who undergo radical hysterectomy for cervical cancer. Non-surgical treatments should be considered in these patients.
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    ABSTRACT: Objectives 1) To understand whether women who are older when diagnosed with cervical cancer have a poorer survival compared to those younger, and if so, to determine the relative importance of patient, tumor and treatment factors. 2) To review whether older women are candidates for aggressive curative treatment for their cervical cancer and the age related effectiveness and toxicity. Methods A review of the published English literature from 1990-2014 using search terms related to cervical cancer and older age was conducted. Results A number of confounders may influence whether advanced age impacts survival such as patient comorbidities, stage, histology, grade, no or incomplete treatment, less radical surgery, palliative rather than curative treatment, lack of adjuvant radiation after surgery, lower rates of chemotherapy and others. When older women are treated as aggressively as their younger counterparts, survival is the same; however, especially where radiation or chemotherapy are used, toxicities may occur at the same or slightly higher rate. Conclusions The more recent population based studies have larger sample sizes and minimize the biases seen in single centre studies. They have also corrected for confounders giving a more accurate answer concerning the outcomes of older women treated for cervical cancer. Performance status (or “frailty”) and not chronologic age should define the optimal treatment strategy for older women with cervical cancer. Treatment related toxicities can be managed with treatment breaks or dose reductions. For those who receive curative treatment, the outcomes appear similar regardless of age.
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