306PD - Patterns of care of cervical cancer in the elderly: A qualitative review of all published literature

Date 17 December 2016
Event ESMO Asia 2016 Congress
Session Gynaecological cancers
Topics Cervical Cancer
Geriatric Oncology
Presenter Bhanu Venkatesulu
Citation Annals of Oncology (2016) 27 (suppl_9): ix94-ix103. 10.1093/annonc/mdw585
Authors B.P. Venkatesulu, S. Mallick, A.G.F. Thoyattan, G.K. Rath
  • Radiation Oncology, All India Institute of Medical Sciences, 110029 - New Delhi/IN

Abstract

Background

Cancer uterine cervix is the fourth most common cancer worldwide among women. However, there is limited data about elderly patients of cervical cancer and there is gross under-representation of elderly patients in clinical trials. Hence, optimal therapy of such patients is not well formulated.

Methods

We conducted this systematic review of current evidence to assess age specific issues that arise in cervical cancer patients and possible ways to counteract them.

Results

A total of 17338 publications are reported in PubMed till July, 2016 pertaining to cervical cancer. Out of these only 24 publications (full length paper or Meeting proceedings) reported about clinical outcome of elderly patients with cervical carcinoma. These publications report data for a long period of time and as early as 1949. In these publications, out of 14479 patients aged ≥60 years of age, 11279 (77.89%) received external beam radiation. Concurrent chemotherapy has been used in 11 publications. Brachytherapy usage has been reported in 19 publications. In few studies brachytherapy was not used because of fear of toxicity. Overall, Low dose rate (LDR) was the most common modality followed by High dose rate (HDR). The authors have showed technical reasons (48.7%), Comorbidities 69.4% and patient refusal (38.3%) as causes for not delivering brachytherapy. 5 year OS have been found to be inferior to the non-elderly cohort and ranges from 27%-69% for elderly compared to 58%-75% in the non-elderly population. Dismal 11% 5 year OS has been reported for patients treated with suboptimal radiation dose compared to 74% treated with chemo radiotherapy followed by brachytherapy in the elderly.

Conclusions

Gross under-representation of patients above 65 years in clinical trials has resulted in treatment dilemmas in the elderly. With advent of Comphrensive geriatric assessment tools and importance of biological age, elderly cervical cancer patients should get treatment protocols similar to their adult counterparts with emphasis on toxicity limitation and enhancing quality of life by integrating newer radiation technology, biological response modifiers and targeted therapy.

Clinical trial indentification

Legal entity responsible for the study

Bhanu Prasad Venkatesulu

Funding

All India Institute of Medical Sciences

Disclosure

All authors have declared no conflicts of interest.